Simultaneous innervated and vascularized iliac bone flap for reconstructing mandible and nerve defects / 口腔疾病防治

@#The functional reconstruction of large maxillofacial defects is a major issue in oral and maxillofacial surgery, and autologous bone transplantation is the main method. However, bone is readily absorbed following an autologous bone transplant. Even with vascular anastomosis, spontaneous osteoporosis of transplanted bone is still serious, which affects dental implantation and functional recovery. Therefore, osteoporosis of the grafted bone has become one of the main complications of jaw reconstruction, and there is no preventive measure. The problem that autologous bone with sufficient blood supply cannot avoid osteoporosis suggests that systemic factors such as nerves, which have been neglected in traditional methods, may regulate the internal environment of the transplanted bone. Based on previous studies on the regulation of mesenchymal stem cells by the neural microenvironment, we initiated a new surgical procedure for innervated and vascularized iliac bone flaps based on animal model and cadaver studies. In the innervated and vascularized iliac bone flap, vascular microanastomosis was performed in conjunction with microneuronal anastomosis between the simultaneously harvested ilioinguinal nerve (which innervates the iliac bone and is usually sacrificed and neglected in the conventional vascularized iliac bone flap) and the inferior alveolar nerve proximally and with the mental nerve distally. By conducting clinical retrospective studies and prospective randomized controlled trials, we proved that the novel method of simultaneous innervated iliac bone transplantation can not only prevent bone resorption but also restore the sensation of adjacent soft tissues such as the lip. This may solve the key problems of sensory loss and osteoporosis after mandibular reconstruction, ensure the success of dental implant dentures, and put forward the new concept of "blood supply + innervation" bi-system bone transplantation.

Morphometric Evaluation of Mental Foramen of Dry Adult Human Mandibles of South Indian Population and Their Clinical Correlation

Introduction: Morphometric assessment of mental foramina (MF) of the mandible for its variable position is considered to be helpful for the surgeons and dentists for the localized surgical procedures and for the anesthetists to execute nerve block practices. Hence the objective of the present study is to establish the morphometric variability in the position of MF in terms of gender in the mandibles of Southern Indian origin with possible clinical implications. Methods: The shape, size, and location of MF were measured on both sides of the mandible (n=92). Location of MF was established by measuring the distance from MF to the [1] mental symphysis [2] alveolar crest, [3] the base of the mandible, and [4] posterior border of the ramus of the mandible. All the morphometric data were analyzed statistically with a significance level of p<0.05. Results: The higher incidence (58.7%) of rounded MF was recorded. There were no cases of MF anterior to the first pre-molar and below the 1st molar. Most of them (45.7%) were below the 2nd premolar. There was a significant association between gender and the position of the MF (p=0.011). But, no association between gender and side as well as the shape was noted. Significant associations were found between gender and the distance from mental foramen to the posterior border of the ramus and also to the alveolar crest. A significant association between the gender and the positions of the MF was noted. Conclusion: The variations observed from previous studies might be related to the feeding habits of different regions which may ultimately, affect the development of mandibles. Prior knowledge regarding the common positions of MF in local populations is helpful in effective nerve blocks and maxillofacial surgeries.

Vestibular landmarks to minimize injury to the mental nerve during transoral endoscopic thyroidectomy-vestibular approach (TOETVA) procedure: an anatomical study / Puntos de referencia vestibulares para minimizar la lesión del nervio mentoniano durante el procemiento de abordaje vestibular de tiroidectomía endoscópica transoral (TOETVA): un estudio anatómico

SUMMARY: The aim of this study is to reveal the morphometry of the mental nerve to describe a safe zone for minimizing mental nerve damage during transoral endoscopic thyroidectomy-vestibular approach (TOETVA). This study was performed on 12 cadavers. Localization of mental foramen according to teeth, distances of buccogingival sulcus-lip (BG-L), mental foramen-midline (MF-Midline), mental foramen - buccogingival sulcus (MF - BG), commissure - branching point (Cm - Br), branching point - vertical projection of branching point on lower lip (Br - LVP), vertical projection of branching point on lower lip - commissure (LVP - Cm), commissure - midline (Cm - midline), angles of mental (AM), angular (AA) and labial branches (AL) and branching patterns were recorded. Type 1 was mostly found as branching pattern in this study (45.8 %). A new branching pattern (type 9) was found on one cadaver. Mental foramen was mostly located at level of second premolar teeth. According to morphometric results of this study; supero- lateral to course of angular branch and infero-medial to course of mental branch of mental nerve on lower lip after exiting the mental foramen were described as safe zones during surgery for preserving mental nerve and its branches.

RESUMEN: El objetivo de este estudio fue revelar la morfometría del nervio mental o mentoniano para describir una zona segura y de esta manera, minimizar el daño de este nervio durante la tiroidectomía endoscópica transoral-abordaje vestibular (TOETVA). Este estudio se realizó en 12 cadáveres. Se realizó la localización del foramen mentoniano según los dientes, distancias surco gingival-labio (BG-L), foramen mentoniano-línea mediana (MF-Midline), foramen mentoniano-surco gingival (MF-BG), comisura-punto de ramificación (Cm-Br), punto de bifurcación - pro- yección vertical del punto de bifurcación en el labio inferior (Br - LVP), proyección vertical del punto de bifurcación en el labio inferior - comisura (LVP - Cm), comisura - línea mediana (Cm - línea mediana), ángulos del mentón (AM). Se registraron ramos angulares (AA) y labiales (AL) y patrones de ramificación. El tipo 1 se encontró principalmente como patrón de ramificación en el 45,8 %. Se describe un nuevo patrón de ramificación (tipo 9) encontrado en un cadáver. El foramen mentoniano se localizaba mayoritariamente a nivel de los segundos premolares. Según los resultados morfométricos, supero-lateral al curso de la rama angular e infero-medial al curso de la rama mentoniana del nervio mentoniano en el labio inferior, después de salir del foramen mentoniano, se describieron las zonas seguras, para la cirugía y preservación del nervio mentoniano y de sus ramos.

A CBCT aided assessment for the location of mental foramen and the emergence pattern of mental nerve in different dentition status of the Saudi Arabian population / Avaliação auxiliada por CBCT para a localização do forame mentual e o padrão de emergência do nervo mentual em diferentes estados de dentição da população da Arábia Saudita

Objective: The anatomy of mental foramen (MF) is a noteworthy landmark during any surgical procedures in the inter-foraminal region. Thus, the study aims at evaluating the location of MF and the emergence pattern of MN in three status of dentition in Saudi Arabian population. Material and Methods: In a prospective study, we have analyzed 240 cone beam computed tomography (CBCT) for the location of MF and the emergence pattern of MN. The study comprising three groups, namely dentulous, partially edentulous and edentulous, each having eighty CBCT scans. We presented the data in percentages. The chi-square and McNemar's test were used for testing association and pair-wise analysis, respectively. Results: The most common location of MF was below the apex of the second premolar irrespective of dentition status, with 54.2% in right and 60% in the left side of the jaw. Among the dentition status, left side of the mandible has shown significant variation for the location of MF, whereas gender and age showed variation in the right side. Anterior loop (AL) (Type-III) the emergence pattern of MN was the highest in all dentition status, with 51.7% in right and 53.8% on the left side. The variation in the emergence pattern of MN in terms of gender and side of the jaw was statistically significant. Conclusion: In the Saudi Arabian population, the apex of second premolar and type III/AL was the most prevalent location of MF and the emergence pattern of MN, respectively (AU)

Introdução: Objetivo: A anatomia do forame mentual (FM) é de grande importância durante qualquer procedimento cirúrgico na região inter-foraminal. Por tanto, como objetivo o estudo visa avaliar a localização do FM e o padrão de emergência do NM em três estados de dentição na população da Arábia Saudita. Material e Métodos: Em um estudo prospectivo, analisamos 240 tomografias computadorizadas de feixe cônico (TCFC) para a localização do FM e o padrão de emergência de NM. O estudo compreendeu três grupos, a saber, dentados, parcialmente edêntulos e edêntulos, cada um com oitenta imagens de TCFC. Apresentamos os dados em porcentagens. O teste do Qui-quadrado e o teste de McNemar foram usados para testar associação e análise de pares, respectivamente. Resultados: A localização mais comum do FM foi abaixo do ápice do segundo pré-molar independente do estado da dentição, com 54,2% no lado direito e 60% no lado esquerdo da mandíbula. Dentre as condições da dentição, o lado esquerdo da mandíbula apresentou variação significativa para a localização dos FM, enquanto o sexo e a idade mostraram variação no lado direito. O padrão de emergência (Tipo III) da alça anterior (AL) do NM foi o mais alto em todos os estados de dentição, com 51,7% no lado direito e 53,8% no lado esquerdo. A variação no padrão de emergência de NM em termos de gênero e lado da mandíbula foi estatisticamente significativa. Conclusão: Na população da Arábia Saudita, o ápice do segundo pré-molar e tipo III / AL foi a localização mais prevalente de FM e o padrão de emergência de NM, respectivamente. (AU)

Bloqueo de nervio mentoniano para braquiterapia de carcinoma de labio / Mental nerve block for brachytherapy of lip carcinoma

Introducción: El cáncer de labio es el tumor más frecuente de la cavidad oral que afecta, sobre todo, el labio inferior. La braquiterapia es un tratamiento único eficaz en estadios tempranos y como terapia adyuvante a la cirugía en estadios avanzados. Esta técnica es un proceso doloroso por lo que para su realización se han empleado sedaciones profundas, infiltraciones intramusculares de anestésico local y técnicas de anestesia regional, entre otras. Objetivo: Presentar una técnica anestésica diferente y poco descrita como alternativa para disminuir el dolor de la intervención. Presentación del caso: Paciente con carcinoma de labio programado para braquiterapia. Se realiza bloqueo del nervio mentoniano de manera bilateral para el tratamiento en labio inferior. Conclusiones: Este tipo de bloqueo, por su sencillez y eficacia, es una alternativa útil a la sedación profunda para la realización de braquiterapia en el labio inferior(AU)

Introduction: Lip cancer is the most frequent tumor of the oral cavity that affects, above all, the lower lip. Brachytherapy is a unique treatment which is effective in early stages and, as adjuvant therapy to surgery, it is also effective in advanced stages. This technique is a painful process, a reason why deep sedation, intramuscular infiltrations of local anesthetic, and regional anesthesia techniques, among others, have been used. Objective: To present a different and scarcely described anesthetic technique as an alternative to reduce the pain of this intervention. Case presentation: Patient with lip carcinoma scheduled for brachytherapy. Bilateral mental nerve block is performed in the lower lip. Conclusions: This type of block, due to its simplicity and effectiveness, is a useful alternative to deep sedation for brachytherapy in the lower lip(AU)

Prevalence of mental nerve injury in facial fractures: a 3 year retrospective study

Background: Mandibular fracture is the most common facial bone fracture. Fractures occurring at the Para symphysis region frequently results in mental nerve injury, due to which anaesthesia or paraesthesia of the skin and mucous membrane within the distribution of mental nerve may be observed and may cause reduced quality of life for patients. Aim of this study was to retrospectively analyse and evaluate the prevalence rate of mental nerve injury in patients that reported to the department of oral and maxillofacial surgery, managed conservatively or open reduction and internal fixation method during the last 3 yearsMethods: Patients with neurosensory deficit following para symphysis fracture were recorded, statistically analyzed and results and observation were prepared from it.Results: The patients with age group 21-30 diagnosed with para symphysis fracture constituted 25% of all operated case and were found to be more associated with midface and angle fracture. Etiology behind the trauma was mostly as a result of RTA. Neurosensory disturbances as a result of mental nerve injury were found to be associated in 20.89% case, out of which in most of the cases, it gradually recovered within a duration of 7-15 days.Conclusions: RTA’s have been a prime cause for para symphysis fracture, which may at times accompany neurosensory deficit following trauma or may occur post-surgery, has been found to cause troublesome sequelae and reduced quality of life. Moreover, further research study needs to be carried out over a larger time span having a larger group of patients.

The mental foramen in dry human mandibles of adult South Africans: an anatomical study / El foramen mental en mandíbulas humanas secas de adultos sudafricanos: un estudio anatómico

The objective of the study was to investigate the position, position symmetry, shape and number of the mental foramen in a heterogeneous South African population. Knowledge of the precise position of MF in maxillofacial surgery is critical for an accurate local anaesthesia; and can provide a landmark in forensic or medico legal cases. Dry adult human mandibles (n = 325) were selected and classified by ancestry. The sample comprised male-to-female ratio of 1.2:1. Observations were made for the position, position symmetry, shape and number of the mental foramen. There was a substantial to perfect agreement (p < 0.001) for most observations, except for the shape of the MF on the right side of the mandible that had a fair agreement (K = 0.25; P > 0.05). PIV of the MF is shown as the most prevalent position. PIII and IV were commonly observed in males and females respectively. PII was commonly observed in the males of European descent, while PIII was observed in male African and Mixed descents and female European descents. There was no significant difference in the symmetric analysis of MF amongst male and female (p = 0.059) and between ancestry (p = 0.455). But also, an oval shape of MF was the most common across subpopulations and ancestries, with 2 (2 %) and 3 (0.46 %) of the AMFs present. This study is the first comprehensive description of the MF in the South African population, and could be very useful in forensic anthropology in the South Africa population.

El objetivo de este estudio fue investigar, en una población sudafricana heterogénea, la posición, simetría de posición, forma y número de forámenes mentales (FM). El conocimiento de la localización exacta del FM en la cirugía maxilofacial es crítico para una anestesia local precisa y puede proporcionar un punto de referencia en casos legales forenses o médicos. Se seleccionaron 325 mandíbulas humanas secas adultas y clasificadas por ascendencia. La muestra relación hombre-mujer fue de 1,2:1. Las observaciones fueron realizadas para la posición, simetría de la posición, forma y el número forámenes mentales. Se alcanzó la perfección de concordancia (p < 0,001) para la mayoría de las observaciones, a excepción de la forma intermedia en el lado derecho de la mandíbula el cual presentó un acuerdo justo (K = 0,25; p > 0,05). La PIV de la MF se muestra como la posición más prevalente. PIII y IV fueron observados comúnmente en hombres y mujeres, respectivamente. La PII se observó comúnmente en los varones de ascendencia europea, mientras que el PIII se observó en descendientes africanos y mixtos masculinos y descendientes femeninos europeos. No hubo diferencias significativas en el análisis simétrico del FM entre hombres y mujeres (p = 0,059) y entre ascendencia (p = 0,455). Una forma ovalada de FM fue la más común a través de subpoblaciones y ancestros, con 2 (2 %) y 3 (46 %) del con la presencia de un foramen mental accesorio. Este estudio es la primera descripción comprensiva del FM en la población sudafricana, y podría ser muy útil en antropología forense en la población de Sudáfrica.

Evaluation of incidence of mental nerve loop in Central India population using cone beam computed tomography

Anatomical literature has described the anterior loop being an extension of the mental nerve which is present anterior to the mental foramen while the caudal loop has been described as the distance between the lower border of the mental foramen and the lowest point of the mandibular canal. The knowledge and identification of the anterior and caudal loop of the mental nerve are important in surgical procedures performed around the mental foramen to avoid inadvertent damage to these vital structures resulting in postoperative complications. Aim: The present study was conducted to determine the incidence and measurement of mental nerve loop in the mandibular arches using cone beam computed tomography (CBCT). Settings and Design: A total of 200 CBCT images were retrieved and inspected for the presence of the mental nerve loop. The length of the anterior loop was measured by counting the number of consecutive contiguous vertical cross sections displaying two round hypodense images. This number was multiplied by the thickness of the slices. The caudal loop was measured as the distance between the lower border of the mental foramen and the lowest point of mandibular canal. Statistical Analysis Used: Shapiro–Wilk test and Mann–Whitney U-test were used. P < 0.05 was considered statistically significant. Results: 57.5% (n = 200 scans) presented with the anterior loop of the mental nerve with a mean length of 0.50 mm and 0.37 mm on the right side and left side, respectively. All the samples of CBCT scans taken were having caudal loop extension with a mean length of 3.53 mm. Conclusion: A considerable number of individuals (57.5%) in the present study presented with the anterior loop of the mental nerve. CBCT was found to be an effective imaging modality for the detection of anterior loop of the mental nerve.

Morphological and morphometric analysis of accessory mental foramen in dry human mandibles of south indian population

Mental foramen (MF) is an important landmark for administration of local anesthesia in surgical procedures involving the mandible. Additional mental foramina, called accessory mental foramina (AMF) transmitting branches of mental nerve, have been reported. Detection of AMFs in presurgical imaging may reduce postoperative pain in dental surgical procedures. Aim: The aim of the study was to study the incidence and morphometric analysis of accessory MF in the dry human mandibles of South Indian population. Materials and Methods: Two hundred and sixty dry human mandibles were studied for the presence, location, shape of AMF, and its relation to MF. The horizontal diameter of AMF, and its distance from symphysis menti, the posterior border of mandible and from the base of mandible were measured and statistically analyzed. Results and Conclusions: In our study, AMF were present in 8.85% mandibles (unilateral - 7.6% [4.6% - left, 2.69% - right] and bilateral 1.6%). The most common position was below the second premolar (48.1%). AMF were round in shape (74%) and was often located either superomedial or inferolateral to MF. Their transverse diameter ranged from 0.5 to 1 mm. The AMF were situated at a mean distance of 2.96 mm from MF, 23.47 mm from symphysis menti, 11.24 mm from the lower border of the body of the mandible, and 57.35 mm from the posterior border of ramus of mandible. The knowledge of the presence of AMF and its dimensions would enable the clinicians to do mandibular procedures carefully and avoid injury to the branches of mental nerve that may be passing through it.

Accuracy in the diagnosis of the mental nerve loop: a comparative study between panoramic radiography and cone beam computed tomography / Precisión en el diagnóstico del bucle del nervio mental: estudio comparativo entre radiografía panorámica y tomografía computadorizada de haz cónico

Dental implant and chin osteotomy are executed on the mandible body and the mental nerve is an important anatomical limit. The aim of this research was to know the position of the mental nerve loop comparing result in panoramic radiography and cone beam computed tomography. We analyzed 94 hemimandibles and the patient sample comprised female and male subjects of ages ranging from 18 to 52 years (mean age, 35 years) selected randomly from the database of patients at the Division of Oral Radiology at Piracicaba Dental School State University of Campinas; the anterior loop (AL) of the mental nerve was evaluated regarding the presence or absence, which was classified as rectilinear or curvilinear and measurement of its length was obtained. The observations were made in the digital panoramic radiography (PR) and the cone beam computed tomography (CBCT) according to a routine technique. The frequencies of the AL identified through PR and CBCT were different: in PR the loop was identified in 42.6% of cases, and only 12.8% were bilateral. In contrast, the AL was detected in 29.8% of the samples using CBCT, with 6.4% being bilateral; Statistical comparison between PR and CBCT showed that the PR led to false-positive diagnosis of the AL in this sample. According to the results of this study, the frequency of AL is low. Thus, it can be assumed that it is not a common condition in this population.

Implantes dentales y la osteotomía de mentón son realizadas en el cuerpo mandibular y el nervio mental es un importante limite anatómico. El objetivo de esta investigación es conocer la posición del bucle del nervio mental comparando resultados entre radiografia panorámica y tomografía computadorizada de haz cónico (TCHC). Fueron analizadas 94 hemimandíbulas; la muestra de pacientes de sexo feminino y masculino con edades fluctuando entre 18 y 52 años (edad media, 35 años) seleccionados de la base de datos de pacientes de la División de Radiología de la Facultad de Odontología de Piracicaba, Universidad Estadual de Campinas; el bucle anterior (BA) del nervio mental fue evaluado según su presencia o ausencia, el cual fue clasificado como rectilíneo o curvilíneo obteniéndose el largo total del bucle; las observaciones fueron realizadas en radiografías panorámicas digitales (RP) y en TCHC de acuerdo a técnicas de rutina. La frecuencia de identificación del BA en RP y TCHC fue diferente: en la PR, el BA se identificó en un 42,6% de los casos y solo el 12,8% fue bilateral. En contraste, el BA fue detectado en el 29,8% de la muestra utilizando TCHC, con un 6,4% bilateral; la comparación estadística entre RP y TCHC muestra que la RP lleva a diagnósticos falsos positivos de la muestra de BA. De acuerdo con los resultados de este estudio, la frecuencia de BA es baja. Por este motivo se puede asumir que esta es una condición anatómica poco frecuente en la población estudiada.

Radiographic study of the mental foramen in a Mongolian population / Шинэ санаа Шинэ нээлт

BACKGROUNDPurpose of this study was to investigate the most common position of the mental foramen in a selected Mongolian population. The study sample included two hundred and twenty two panoramic radiographs of selected Mongolian population taken in School of Dentistry, Health Sciences University of Mongolia.RESULTSThe patients’ age ranged from 16 to 66 years, with a mean age of 27.4 years. The most common position of the mental foramen was in line with the second premolar (58.8%). Ethnic and gender differences were also investigated and the symmetry of location within individuals analyzed. In 30.2%, it was between the first and second premolar, and in 2.5%, it was below the first premolar. It is important to know the position of the mental foramen for the placement of osseointegrated implants in the mandibular premolar region.CONCLUSIONClinicians and anthropologists should expect to find the position of the mental foramen to be symmetrical and in line with the second premolar teeth.

Ultrasound-Assisted Mental Nerve Block and Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia: Three Case Studies

Postherpetic neuralgia (PHN) is one of the most difficult pain syndromes to treat. Invasive treatments may be considered when patients fail to obtain adequate pain relief from noninvasive treatment approaches. Here, we present three cases of PHN in the mandibular branch treated with ultrasound-assisted mental nerve block and pulsed radiofrequency treatment. None of the patients had adequate pain relief from the medical therapy, so we performed the mental nerve block on the affected side under ultrasound assistance. Two patients showed satisfactory pain relief continuously over 12 months without any further interventions, whereas one patient only had short-term pain relief. For the patient had short-term pain relief we performed pulsed radiofrequency treatment (PRFT) on the left mental nerve under ultrasound assistance. After PRFT, the patient had adequate pain relief for 6 months and there was no need for further management.

Mental nerve paresthesia secondary to initiation of endodontic therapy: a case report

Whenever endodontic therapy is performed on mandibular posterior teeth, damage to the inferior alveolar nerve or any of its branches is possible. Acute periapical infection in mandibular posterior teeth may also sometimes disturb the normal functioning of the inferior alveolar nerve. The most common clinical manifestation of these insults is the paresthesia of the inferior alveolar nerve or mental nerve paresthesia. Paresthesia usually manifests as burning, prickling, tingling, numbness, itching or any deviation from normal sensation. Altered sensation and pain in the involved areas may interfere with speaking, eating, drinking, shaving, tooth brushing and other events of social interaction which will have a disturbing impact on the patient. Paresthesia can be short term, long term or even permanent. The duration of the paresthesia depends upon the extent of the nerve damage or persistence of the etiology. Permanent paresthesia is the result of nerve trunk laceration or actual total nerve damage. Paresthesia must be treated as soon as diagnosed to have better treatment outcomes. The present paper describes a case of mental nerve paresthesia arising after the start of the endodontic therapy in left mandibular first molar which was managed successfully by conservative treatment.

Submerged mandibular carious deciduous second molar along with an impacted second premolar associated with an atypical inflammatory follicular cyst: A rare case report.

The author presents a case of submerged carious deciduous molar along with an inflammatory atypical follicular cyst associated with an impacted mandibular second premolar in the right mandible identified through clinical and routine radiological examination including cone beam computed tomography and histopathology. The involvement of submerged deciduous molar with dental caries by itself a rare occurrence and an impacted permanent premolar tooth associated with an infected follicular cyst is still more a rare event.

Paresthesia of the Lower Lip: Delayed Complication of Radiotherapy to Nasopharynx.

Paresthesia of the lower lip may develop following injury to the inferior alveolar nerve or mental nerve. The most common cause of lip paresthesia is iatrogenic where inadvertent injury takes place during surgery. Paresthesia may also develop as a result of pathology interfering with the integrity of nerve. While expanding benign lesions cause paresthesia by compression of the nerve, malignant lesions do so by invading the nerve tissue. Ionizing radiation may also cause damage to the nerves. The adverse effects of radiation therapy on oral health are well known with the most emphasis given to osteoradionecrosis. Our case is the first report that the inferior alveolar nerve or mental nerve is at risk of long term side effects of radiotherapy to the nasopharyngeal region.

Mandibular ridge extension with bilateral inferior transposition of mental nerve.

In case extensive atropy of the alveolar process of the mandible may result in the mental foramen becoming located on or near the crest of the residual ridge. This frequently is the cause of discomfort for the denture wearers. When adjustment of the denture does not alleviate the problem, it may be necessary to transpose the nerve and this is also indicated when the alveolar sulcus is to be deepened in this region. We presented case of severely resorbed mandibular ridge with chief complaint of numbness and discomfort over wearing denture which is treated by supraperiosteal vestibuloplasty with bilateral inferior transpositioning of mental nerve. This management resulted in increased vestibular depth for denture retention and stability, as well as it helped us to avoid numbness and discomfort.

Study of position, shape, size and incidence of mental foramenand accessory mental foramen in indian adult human skulls / Estudio de la posición, forma, tamaño e incidencia del foramen mentoniano y foramen mentoniano accesorio en cráneos humanos de indios adultos

Paralysis of the mental nerve is one of the principal complications of surgery of the mandibular canal and mental foramen region. Therefore, identification of mental foramen is important for dental surgeons in nerve block and surgical procedures like apico curettage of mandibular premolars, amalgam filling, peridental surgery etc. to avoid injury to neurovascular bundle. Accessory mental foramina tend to exist in the apical area of the first molar and posterior or inferior area of the mental foramen. The accessory branches of the mandibular canal showed common characteristics in the course of gently sloping posterosuperior direction in the buccal surface area. Verification of the existence of accessory mental foramina would prevent accessory nerve injury during periapical surgery. In root canal treatment, the possibility of accessory mental foramina­related nerve paresthesia seems low unless the mental foramen and mandibular canal are injured. Therefore, prior surgical knowledge of morphology and morphometry of mental and accessory mental foramen peculiar to particular block may enable effective mental block anaesthesia. Besides this, as mental foramen and accessory mental foramen have been found to vary in position in different ethnic groups. So, it is important to study the morphology and morphometry of mental foramen and accessory mental foramen. Hence this study was carried out. Present study was conducted using dried adult human mandibles of both sexes. Size and position were determined using digital vernier callipers. Incidences and shapes of mental foramen and accessory mental foramen were also observed. Mental foramen was present in all one hundred observed mandibles and it is bilateral. Accessory mental foramen was present in 8 percent on left side while on right side, it was 5 percent. None of the mandibles presented with bilateral accessory mental foramen. Shape was predominantly round with 94 percent on right side and 87 percent on left side while...

La parálisis del nervio mentoniano es una de las principales complicaciones de la cirugía del canal mandibular y la región del foramen mentoniano. Por lo tanto, la identificación del foramen mentoniano es de gran importancia para cirujanos dentistas en el bloqueo del nervio y los procedimientos quirúrgicos como el legrado ápical de premolares inferiores, obturación de amalgamas, la cirugía periodental, etc., a fin de evitar lesiones del paquete neurovascular. Los forámenes mentonianos accesorios tienden a existir en la zona apical del primer molar y la zona posterior o inferior del foramen mentoniano. Las ramas accesorios del canal mandibular presentan características comunes en el curso de la leve pendiente de dirección posterosuperior de la superficie bucal. Verificar la existencia de forámenes mentales accesorios evitaría la lesión del nervio accesorio durante la cirugía periapical. En el tratamiento del canal radicular, la posibilidad parestesia relacionada con daño de los forámenes mentonianos accesorios es baja a menos que el foramen mentoniano y el canal mandibular se lesionen. El conocimiento de la morfología y la morfometría del foramen mentoniano y los forámenes mentonianos accesorios puede permitir un efectivo bloqueo anestésico mentoniano, y es fundamental previo a una cirugía. Además de esto, se ha encontrado que los forámenes varían en su posición en diferentes grupos étnicos, siendo importante estudiar su morfología y morfometría. Se realizó el estudio sobre mandíbulas humanas adultas secas, de ambos sexos. El tamaño y la posición de los forámenes se determinaron utilizando calipers digitales. La incidencia y la forma del foramen mentoniano y forámenes mentales accesorios también fueron observados. El foramen mentoniano estaba presente en las 100 mandíbulas observadas, y fueron bilaterales. Forámenes mentales accesorios estaban presente en un 8 por ciento en el lado izquierdo, mientras que en el lado derecho, un 5 por ciento...

Numb chin syndrome: A case report and review of the literature.

Numbness of the lower lip, the skin of the chin, or the gingiva of the lower anterior teeth secondary to various dental diseases is a common manifestation that is largely underappreciated. The association of numb chin syndrome (NCS) with serious disease like metastatic malignancy and systemic conditions is frequent enough to warrant a search for these possible etiologies. In this paper we report a case of NCS that occurred secondary to malignant disease; we discuss our findings with special emphasis on metastatic malignancies leading to NCS, when the survival is only for a few months.

Radiographic evaluation of the mental foramen in a selected Iranian population.

Background: Information on the position of the mental foramen is important for dental surgeons. Variations in its position can be a cause of complications during local anesthesia or surgical procedures. The usual position of the mental foramen in an Iranian population has not been previously reported. Aims: The purpose of this study was to determine the most common location of the mental foramen in an Iranian population. We also analyzed gender differences and the symmetry of location within individuals. Materials and Methods : 400 panoramic radiographs were evaluated with regard to the location and symmetry of the mental foramina in male and female subjects. Results : We found that the mental foramen was located between the first and second premolars in 47.2% of patients and in line with the second premolar in 46%. In 49.2% of males, the mental foramen was in line with the second premolar. In 50.9% of females it was between the first and second premolars. It was symmetrical in 85.7%. Conclusions : Based on this study it appears that the most common position of mental foramen is either between the two premolars or in line with the second premolar. This is in concordance with previous studies.

The techniques of studying normal blink reflex / 实用口腔医学杂志

Objective:To investigate the different techniques and wave characteristic of applying non-invasive stimulation in blink reflex.Methods:Thirty volunteers participated in this study.Using the electrodiagnostic techniques,the orbital nerve and mental nerve were stimulated and the waves were respectively recorded at orbicularis oculi and levator labli superioris,then concluded the latency and amplitude of R1,R2,R2'.Results:The results of blink reflex were basically identical with the normative criteria.The wave of stimulating the orbital nerve and recording at levator labli superioris resembled BR.The images were steady and repeatable.The waves of stimulating mental nerve and recording at orbicularis oculi and levator labli superioris were unstable and partial R1 absent.Conclusion:The techniques of stimulating orbital nerve and recording at orbicularis oculi and levator labli superioris are valuable in the initial investigation of trigemino-facial reflex.The techniques of stimulating mental nerve and recording at orbicularis oculi and levator labli superioris can be used to examine assistantly.