Variations of the Lingula and Mandibular Ramus in the Context of Sagittal Split Ramus Osteotomy: A Cone Beam Computed Tomography Study Supporting an Ethnic-Centric Approach to Orthognathic Surgery.

OBJECTIVES: To investigate the ethnic variations concerning the lingula and ramus of the mandible, with particular emphasis on sagittal split ramus osteotomy (SSRO) in orthognathic surgery. MATERIALS AND METHODS: This study examined Cone beam computed tomography (CBCT) scans from the Kenyan and Malay populations. Lingula morphology was classified into four categories. Morphometric measurements included lingula size, height above the occlusal plane, distance to the second mandibular molar, and distance from its apex to all four mandible borders. Regarding the ramus of the mandible, the thickness of each cortical plate, trabecular bone, and overall thickness were determined at two points. Furthermore, points of fusion of cortical plates were determined in both the vertical and horizontal planes. RESULTS: Among Kenyans, the triangular shape was most common (46.5%, n = 80 sides), while truncated was most common among Malays (34.4%, n = 57 sides). The overall mean size of lingula differed significantly between Kenyan (7.37 ± 2.19 mm) and Malay (4.14 ± 2.50 mm) populations (p<0.001). The lingula was more located postero-superiorly in Kenyans compared to Malays (p < 0.001). The mean distance from the distal aspect of the second mandibular molar to the lingula was 38.37 ± 4.98 mm among Kenyans, in contrast to 31.95 ± 0.03 mm among Malays (p < 0.001). The Malays exhibited a thicker mandible with a larger trabecular distance (5.99 ± 1.41 mm and 3.41 ± 1.29 mm, respectively) than Kenyans (5.28 ± 1.39 mm and 1.98 ± 0.98 mm, respectively) (p < 0.001). The points of fusion of the cortical plates differed significantly between Kenyans and Malays. CONCLUSION: This study focuses on two ethnic groups, Kenyans and Malays, and brings to light the ethnic-based differences in the position of the lingula and the dimensions of the mandibular ramus, both of which are essential considerations in orthognathic surgery. Preoperative consideration of such variations is warranted, potentially mitigating iatrogenic injuries and enhancing successful patient outcomes.

Determining the position of the lingula and the mandibular foramen using the antilingula in orthognathic surgery.

BACKGROUND: The antilingula located on the lateral surface of the mandibular ramus has been served as a surgical landmark for the mandibular foramen on the medial surface for decades. However, whether the antilingula truly represents the lingula which is the bony prominence overlapping the mandibular foramen, or the foramen itself, is still unclear. This study thus aimed to examine the position of the antilingula in relation to three reference points: the lingula, the anterior and the posterior borders of the mandibular foramen, as well as to the reference plane used in the inferior alveolar nerve block, and to the posterior border of the mandible. METHODS: This observational study was performed in 113 Thai dry mandibles. The antilingula were identified followed by transferring the reference points to the lateral surface. The distances from the antilingula to the reference points, the reference plane and the posterior border of the ramus were then measured. Chi-square test was calculated for side-dependency of the antilingula. Paired t-test was calculated for difference in measurements in left and right sides. RESULTS: The antilingula could be identified in 92.48% of the mandibles with 86.67 - 90.00% accuracy and 86.67% reliability. There was no significant difference in the presence of the antilingula on left and right sides (p = 0.801). Only 2.5% and 0.83% of the antilingula correspond to the lingula and the anterior border of the mandibular foramen, respectively. However, 85% of the reference points were located within 11 mm radius. The antilingula was found located 2.80 mm inferior to the reference plane and 16.84 mm from the posterior border of the ramus. CONCLUSIONS: The antilingula does not concur with the reference points on the medial surface. Our study also suggests that the safe area for vertical osteotomy is 11 mm posterior to the antilingula or at 30% of the length from the posterior border parallel to the occlusal plane. The use of more accurate techniques in localizing the mandibular foramen combined with the antilingula is more recommended than using the antilingula as a sole surgical guide.

Use of Adult Dry Human Mandibles to Study of Mandibular Foramen from Various Bony Landmarks.

Background: Precise knowledge of the mandibular foramen's location is essential for clinical and surgical procedures, especially the inferior alveolar nerve block. Variability in its position concerning different bony landmarks can significantly impact clinical outcomes. Materials and Methods: This study examined 30 Adult dry human mandibles to determine the mandibular foramen's positions in relation to specific bony landmarks: the occlusal plane, posterior border of the ramus, and lingula. Measurements were obtained using a calibrated digital caliper, and statistical analysis was performed. Results: The study revealed significant variations in the position of the mandibular foramen. In relation to the occlusal plane, the mandibular foramen was found at an average height of approximately 15.2 mm (±2.1 mm). Regarding the posterior border of the ramus, it was situated at an average distance of about 18.5 mm (±3.4 mm). In relation to the lingula, the average distance was approximately 21.8 mm (±4.0 mm). These results underscore the considerable individual differences and anatomical variations in the mandibular foramen's location among the studied specimens. Conclusion: The observed variations in the position of the mandibular foramen emphasize the need for clinicians and surgeons to be cognizant of these differences when performing procedures involving the inferior alveolar nerve block. Understanding these anatomical variations is crucial for enhancing clinical precision, reducing complications, and ensuring optimal outcomes.

Comparative mitogenomics of Brachiopods reveals conservatism in articulate species and unusualness in inarticulate species.

BACKGROUND: Brachiopods are a phylum of marine invertebrates with over 10,000 fossil species. Today, there are fewer than 500 extant species assigned to the class Articulata or Inarticulata and for which knowledge of evolutionary genetics and genomics is still poor. Until now, complete mitogenome sequences of two inarticulate species and four articulate species were available. METHODS AND RESULTS: The complete mitogenome of the inarticulate brachiopod species Lingula reevii (20,778 bp) was obtained by using next generation sequencing. It contains 12 protein-coding genes (the annotation of atp8 is unsure), two ribosomal RNA genes, 26 transfer RNA genes, and one supernumerary ORF that is also conserved in the inarticulate species Lingula anatina. It is hypothesized that this ORF could represent a Lingula-specific mtORFan gene (without obvious homology to other genes). Comparative mitogenomics indicate the mitochondrial gene order of L. reevii is unique among brachiopods, and that compared to articulate species, inarticulate species exhibit massive mitogenome rearrangements, deviant ATP8 protein sequences and supernumerary ORFs, possibly representing species- or lineage-specific mtORFan genes. CONCLUSION: The results of this study enrich genetics knowledge of extant brachiopods, which may eventually help to test hypotheses about their decline.

Evaluation of the differences in the localization of the lingula mandibulae according to pubertal development in children: A new anthropological and forensic approach.

OBJECTIVE: This study aims to investigate changes in lingula mandibulae localization before and after puberty and sex differences. DESIGN: 288 panoramic radiographs evaluated retrospectively were divided into four groups according to pubertal development: under and over 10 years old for females and under and over 11 years old for males. Four anatomic sites were used as reference points: (a) the anterior border of the ramus; (b) the posterior border of the ramus; (c) the deepest point of mandibular notch; and (d) the angulus mandibulae. The ratio of the distances from the lingula mandibulae to points (a) and (b) and the ratio of the distances from the lingula mandibulae to points (c) and (d) were determined. Two-way ANOVA was performed to assess differences between subgroups based on sex and puberty, and a Bonferroni post-hoc test was performed for multiple comparisons. RESULTS: Puberty and sex has a significant interaction effect on the vertical location of the lingula mandibulae. Postpubertal lingula mandibulae is positioned proportionally more anteriorly by prepubertal localization. In addition, the lingula mandibulae is situated more posteriorly in females compared to males. A significant interaction effect of puberty and sex was observed in relation to the vertical positioning of the lingula mandibulae. CONCLUSIONS: The spatial localization of the lingula mandibulae and its spatial displacement with age can be used both in estimating sex and the onset of puberty. Changes in the localization of lingula mandibulae according to pubertal development and sex can be used in forensic and anthropological contexts.

The complete anatomy of the mandibular lingula: a meta-analysis with clinical implications.

BACKGROUND: The objective of this meta-analysis was to investigate the anatomical variations of the mandibular lingula (ML) and its relationship to surrounding anatomical structures. Understanding such variations is crucial to help determine the site and depth of a successful inferior alveolar nerve (IAN) anesthetic block as well as a safe area for oral and maxillofacial invasive procedures in order to minimize the risk of neurological or hematological damage to the inferior alveolar nerve. MATERIALS AND METHODS: A systematic search was conducted in which all studies were searched on the anatomy of ML. Major medical databases such as PubMed, Scopus, Embase, Web of Science, Google Scholar, Cochrane Library were searched. RESULTS: All of the results were based on a total of 4694 subjects. The overall height of the ML was found to be 8.17 mm (SE =0.22). The Triangular Type of the ML was found to be the most common one. The pooled prevalence of this variation was found to be 29.33% (LCI = 23.57% ; HCI = 35.24%). The pooled prevalence of the Nodular Type was set to be 27.99% (LCI = 22.64% ; HCI = 33.67%). CONCLUSIONS: The present meta-analysis provides clinically relevant information regarding the shape, location, and height variations of the ML. Understanding such variations of the ML is crucial when performing malocclusion corrections procedures that require the ML as a landmark, namely sagittal split ramus osteotomy, and intraoral vertical ramus osteotomy. Furthermore, effective anesthetic blocks during oral and maxillofacial procedures can be accomplished with a higher success rate if the correct site of injection is identified. The possible locations of the ML should be considered in order to determine the location of the mandibular foramen and, therefore, inferior alveolar bundle in order to prevent motor, sensory, or perfusion pathology during maxillofacial and oral procedures of the lower jaw.

An Anatomical Study of Dry Mandibles to Determine the Important Surgical Reference Points in Ramus Osteotomy - An Evaluative Study.

Introduction: The variable relation and clinical significance of mandibular foramen (MF) and Lingula with inferior alveolar neurovascular bundle (IANB) is important for dental surgeons. Knowing the landmarks on the ramus of the mandible is of paramount importance to perform the surgery without causing damage to the neurovascular bundle. Materials and Methods: This study was conducted on 85 dry adult mandibles of unknown sex and age. The distances were measured from the anatomical reference points (anti-Lingula, Lingula and MF) using digital callipers. Results: The distance from the anti-Lingula to the anterior border of the ramus (A) was significantly longer on the right side (14.91 mm) than on the left side (14.5 mm). There was a significant difference in mean distances between the anti-Lingula and MF of both the sides (P ≤ 0.005). No significant difference was noted in the distances between the Lingula and the Anti-Lingula, observed for the posterior (B, P = 0.75) and the inferior margin of the mandible (D, P = 0.54). However we found correlation of vertical distances of anti-Lingula with Lingula and MF exhibited moderate positive correlation. Discussion: The IANB is prone to damage during mandibular surgery. Using anti-Lingula alone as a reference point is not guaranteed, but it is still an important anatomical landmark for the surgeon to operate.

Venous concerns after lingula sparing left upper lobectomy.

Postoperative ischaemia of the lingula is a complication of left upper lobe trisegmentectomy, usually attributed to a twist of the remaining lingula. It can also be related to other factors such as venous interruption. We report 3 cases of reoperation after lingula-sparing left upper lobectomy for suspected ischaemia. None were related to torsion. Accidental injury of the lingular venous drainage or abnormal venous pattern can be the leading cause of these ischaemia.

Locating the Mandibular Lingula Using Cone-Beam Computed Tomography: A Literature Review.

This study aimed to review the literature on adult mandibular lingula (ML) locations and related distances determined using cone-beam computed tomography (CBCT). A search was conducted for studies on CBCT using the following databases: PubMed, Web of Science, and Embase. The search results were limited to studies published between 1970 and 2021. The inclusion criteria were the investigation of ML location, CBCT, and participants aged ≥18 years. Eligible studies were examined for the distances from the lingual tip to the anterior ramus border, posterior ramus border, sigmoid notch, inferior ramus border, and occlusal plane. Eight studies on CBCT qualified for inclusion in the study. The mean distances from the ML to the anterior ramus border were 15.57 to 20 mm. In most of these, the ML was located above the occlusal plane. No significant differences were observed in the location and related distances for the ML among patients of different sexes, ethnicities, or skeletal patterns.

Morphological Study of the Mandibular Lingula and Antilingula by Cone-Beam Computed Tomography.

The patterns of the lingula and antilingula are crucial surgical reference points for ramus osteotomy. Cone-beam computed tomography (CBCT) provides three-dimensional images, and patient radiation dose is significantly lower for CBCT than for medical CT. The morphology of the mandibular lingula and antilingula of ninety patients (180 sides) were investigated using CBCT. The lingula were classified as having triangular, truncated, nodular, and assimilated shapes. The antilingula were classified as having hill, ridge, plateau, and plain shapes. The patients' sex, skeletal patterns (Classes I, II, and III), and right and left sides were recorded. The most to least common lingula shapes were nodular (37.8%), followed by truncated (32.8%), triangular (24.4%), and assimilated (5%). The most to least common antilingulae were hill (62.8%), plain (18.9%), plateau (13.9%), and ridge (4.4%) patterns, respectively. The lingula and antilingula had identical patterns on both sides in 47 (52.2%) and 46 patients (51.1%), respectively. Sex and skeletal pattern were not significantly correlated to lingula and antilingula shapes. No significant correlation was observed between lingula and antilingula shapes.

Morphological Analysis of the Mandibular Lingula and Its Relation to Antilingula Using Cone-Beam Computed Tomography in the Saudi Population.

Adequate knowledge of the anatomy of the medial aspect of the mandibular ramus is essential in order to prevent inferior alveolar nerve anesthetic failure and nerve injuries associated with mandibular ramal surgical procedures. The purpose of this study was to assess the morphology of the lingula and analyze the correlation of presence probability between the lingula and antilingula using cone-beam computed tomography (CBCT). Three-dimensional images reconstructed from mandibular CBCT images of 125 Saudi individuals (250 sides), aged 16-36 years, were retrospectively evaluated for distribution in the shape of the lingulae. Additionally, the presence probability of the lingula and antilingula was assessed with respect to gender and the mandible (unilateral and bilateral), and correlation between the variables was analyzed. A nodular shape of the lingula was most commonly found (37.6%) followed by a triangular shape (30%). No significant differences were observed between the genders with regard to the presence of the lingula (p = 0.108) and antilingula (p = 0.530). Gender was non-significantly correlated with the presence of the lingula and antilingula, whilst the presence of lingula showed a significant but weak correlation with that of the antilingula (rs = 0.221; p = 0.000). The present study provides information regarding morphological variations of the mandibular lingula in the Saudi population. The presence of the lingula was unassociated with that of the antilingula and hence consideration of the antilingula as the absolute landmark for mandibular ramus surgical procedures seems insufficient.

Microplastics accumulation and human health risk assessment of heavy metals in Marcia opima and Lingula anatina, Phuket.

The concerns over potential health risk from the consumption of Marcia opima (M. optima) and lingulata (Lingula anatina) contaminated by heavy metals (Cd, Pb and Zn) and microplastics in the eastern part of Phuket, Southern Thailand has been assessed. The abundance of microplastics in Marcia opima and Lingulata were 1.86 and 1.24 items/individual, respectively and followed the order: polyethylene terephthalate > polyester > polyvinyl alcohol and polyvinyl chloride. Integrated risk indices using the daily intake (EDIs) for heavy metals consumption (from 0.00001 to 0.00712 mg kg-1 per day) are not exceeded the standards set by the ministry of public health Thailand to pose potential carcinogenic health risk individually. The bioaccumulations and hazard quotient values (<1) showed no risk exists concerning the levels of exposure, however, monitoring heavy metals concentration and microplastic contaminations on a regular basis are necessary to prioritize the local people health from pollutants exposure.

A detailed radiomorphometric analysis of the mandibular foramen, lingula and anti-lingula with a special emphasis on mandibular prognathism.

INTRODUCTION: The aim of this study was to evaluate radiomorphometric differences of mandibular foramen (MF), lingula (Li), and anti-lingula (AL) between prognathic and non-prognathic patients, using cone-beam computed tomography (CBCT). METHODS: A total of 228 3D CBCT images of 57 prognathic and 57 non-prognathic patients were retrospectively evaluated. The distances between MF or Li to occlusal plane (OP), anterior border of ramus (AR), posterior border of ramus (PR), sigmoid notch (SN), gonion (Go) and distances Li to MF were measured. The presence of AL, and the distances to Li were also assessed in both groups. RESULTS: In prognathic patients the mean distances of MF-AR and Li-PR were lesser, and Li-OP was greater (p < 0.05). However, distances from MF or Li to the other ramal landmarks were similar in both groups (p > 0.05). Presence of AL was found at 53 sides in prognathic and 20 sides in non-prognathic groups (p < 0.05). The horizontal distance of Li-MF was greater in prognathic patients (p < 0.05). On the other hand, there was no difference between groups regarding the horizontal distance of Li-Al, and the vertical distances of Li-MF and Li-AL (p > 0.05). CONCLUSION: The present study provided valuable data regarding morphological differences of MF-AR, Li-MF and Li-OP, which should be considered in the preoperative assessment of patients with mandibular prognathism. Presence of AL was more common in prognathic patients and mainly located above Li. 3D CBCT applications facilitated assessment of AL and its relationship with Li.

Morphological Investigation of Mandibular Lingula: A Literature Review.

PURPOSE: The purpose of the study was to review the literature on the shape of the mandibular lingula. METHODS: English articles published from 1970 to 2021 in databases (PubMed, Web of Science, and Embase) were selected. Articles meeting the search strategy were evaluated based on the eligibility criteria (participants aged 18 years and over). Dry mandibles and cone beam computed tomography (CBCT) images were used as research materials. The shapes of mandibular lingula were classified as triangular, truncated, nodular, and assimilated. RESULTS: Based on the eligibility criteria, 10 articles (six with dry mandibles and four with CBCT images) were selected for full-text reading and detailed examination. In the dry mandible group, triangular, truncated, nodular, and assimilated lingula were observed on 446, 398, 232, and 69 sides, respectively. In the CBCT group, nodular, truncated, triangular, and assimilated lingula were observed on 892, 517, 267, and 88 sides, respectively. Therefore, the most common lingula types in the dry mandible and CBCT groups were different. The assimilated type was the least common in both groups. CONCLUSION: In the dry mandible group, the most common lingula type was triangular, followed by truncated, nodular, and assimilated types. In the CBCT group, the most common lingula type was nodular, followed by truncated, triangular, and assimilated types. There were no significant differences in lingula types between the left and right sides of the mandible.

Stasis and diversity in living fossils: Species delimitation and evolution of lingulid brachiopods.

The Lingulidae are often considered living fossils, because they have shown little morphological change since the Paleozoic. Limited morphological variation has also made the taxonomic study of living lingulids challenging. We investigated species diversity and phylogenetic relationships of extant lingulids and show that they are substantially more diverse than realized, demonstrating that morphological stasis was commonly accompanied by speciation. Species delimitation based on cytochrome c oxidase subunit I (COI) gene sequences from 194 specimens sampled from East Asia, Australia, Oceania, and the Americas suggested 14-22 species in the lingulids (9-17 species in Lingula and 4-5 species in Glottidia), in contrast to the 11-12 species currently recognized globally in the family. Four-gene phylogenetic analyses supported the sister relationship between Lingula and Glottidia. Within Lingula, L. adamsi, which possesses large, brownish shells, was recovered as sister to all remaining Lingula species, which have more or less greenish shells. Within the greenish Lingula clade, the 'L. anatina' complex was sister to the clade that includes the 'L. reevei' complex. The 'L. anatina' complex was further separated into two major clades with partly separate ranges centered on (i) temperate East Asia, and (ii) the tropical west-central Pacific. Within Glottidia, Pacific species were nested within Atlantic species. Time-calibrated phylogenetic analyses suggested that Lingula likely originated in the early Cretaceous contrary to a previously proposed hypothesis advocating a Cenozoic origin. The separation of Lingula and Glottidia appears to date from the Mesozoic, not from the Carboniferous, contrary to a previous hypothesis. Overall, our results uncovered substantial cryptic diversity in lingulids, which will form the basis for conservation and further taxonomic revision.

Left upper lobe and lingula torsion after transplantation of single lung with complete major and minor fissures: A case report.

BACKGROUND: Native lung torsion is rare and torsion in a lung transplant is even rarer. CASE PRESENTATION: Here we report a case of left upper lobe (LUL) and lingula torsion in a patient with a unilateral left lung transplantation. The transplant was complicated by a graft with a short pulmonary artery cuff, which required significant vascular reconstruction and manipulation. Additionally, the graft had complete left major and minor fissures, which are documented risk factors for torsion. After 24 h postoperatively, the patient failed to wean off ventilation. The patient was worked up with bronchoscopy, a computed tomography (CT), and a CT angiogram (CTA). A CT without intravenous (IV) contrast showed the findings suggestive of torsion of the LUL and lingula and the CTA confirmed the diagnosis. Immediate re-exploration was performed for detorsion to preserve the vitality of the allograft. Following the failed detorsion, the patient had re-transplantation of the left lung with good results. CONCLUSION: Lung torsion should be watched for in patients with major risk factors like complete fissure. CT and/or CTA are effective tools to confirm the diagnosis.

Morphological analysis of lingula shape in a modern Italian cemeterial population: Clinical and forensic considerations.

The lingula is a small bony projection emerging from the medial ridge of the mandibular foramen, subjected to morphological variations. To date, scientific literature has described four different shapes (truncated, triangular, nodular and assimilated) and the relative distributions in different human populations. However, no data are available on Europeans so far. To this purpose, the present study aims to evaluate the distribution of the lingula shapes in the Italian population and to verify its relevance in ancestry estimation. Lingula was analysed in 235 dry mandibles selected among contemporary Italian cemeterial skeletons. Since only well-preserved sides were considered, 453 sides were evaluated according to a classification method, which includes the description of a fifth shape (the bridge shape) and the presence of mixed morphologies. In our sample, the most prevalent shape was the truncated shape (38.6%), followed by the nodular (26.3%), mixed morphologies (15.2%), triangular (10.8%), bridge (5.1%) and assimilated (4.0%) shapes. Within mixed morphologies, the most prevalent were the nodular/truncated (31.9%), nodular/triangular (30.4%), and nodular/assimilated (23.2%). Differently to previous studies, the lingula morphology could not actually offer a concrete and reliable help to ancestry estimation. However, its shape and extension would assume a stronger clinical influence for the execution and success of the alveolar nerve block used in dental and maxillofacial surgery procedures.

Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery.

Lung hernia, the protrusion of pulmonary tissue outside of the thoracic cage, is a rare radiologic finding. The exact incidence of this condition is not well documented. The etiology is either secondary to underlying congenital conditions which weaken the supporting structures of the thoracic wall or more commonly, post-surgical changes. In this report, we describe the case of a 58-year-old male trauma patient who was involved in a motor vehicle collision. Computed tomography of the head, neck, body, and upper extremities was negative for acute injury, but an incidental left-sided herniation of the lingula between the fifth and sixth intercostal spaces was identified. Computed tomography is superior for identifying imaging lung herniations as chest radiographs may not visualize the defect. Upon further investigation, the patient had a remote history of pneumonia complicated by empyema treated by video-assisted thoracoscopic surgery (VATS). This history, coupled with the absence of traumatic injury to the thorax as well as the presence of pulmonary scarring suggests that the lung herniation was likely chronic and secondary to the VATS procedure. The patient was discharged home without surgical intervention. Asymptomatic lung herniations are typically managed conservatively, but patients and physicians should be aware of the risk of lung hernia after VATS as well as associated complications including strangulation or pulmonary infarct.

An Investigation of the Variations in Complete Mitochondrial Genomes of Lingula anatina in the Western Pacific Region.

Lingula anatina is a brachiopod widely distributed in the western Pacific region. Even though L. anatina has been targeted for a number of biological studies, there is still limited information on intraspecific genetic variations of L. anatina. In this study, L. anatina specimens were collected from Korea and Vietnam, and complete mitochondrial genome (mitogenome) sequences were analyzed and compared with previous records. The total mitogenomes of L. anatina were 24,875 bp and 25,305 bp in size for Korean and Vietnamese specimens, respectively. Those mitogenomes are extraordinarily longer than the typical mitogenome size for an animal but shorter than the previous record from Yanagawa (Japan) for this species. The gene orders and the sizes of the protein-coding genes are also different from those for the Japanese specimen. Furthermore, the nonsynonymous (Ka) and synonymous (Ks) substitution rates in protein-coding genes (PCGs) were calculated to test the idea of evolutionary rate differences in mitochondrial genomes. The analyses showed relatively low Ka and Ks for the complete mitogenomes from Buan (Korea), Doson (Vietnam) and Yanagawa (Japan). The Ka/Ks ratio was less than 1 in comparisons of three localities, indicating the existence of purifying selection in this species. The phylogenetic analyses showed that L. anatina diverged among localities in the western Pacific region.

The correlation between surgical reference points: antilingula, lingula, and mandibular foramen.

The purpose of the present study was to investigate and determine the anatomical relationship between the antilingula, lingula, and mandibular foramen using cone-beam computed tomography (CBCT). METHODS: CBCT images of 90 participants (180 mandibular ramus) were collected. The locations of and distances between the antilingula, lingual, and mandibular foramen according to side (right and left) and skeletal patterns were measured and then evaluated by statistical analysis. RESULTS: Only 27 participants (15%) had bilateral distinct antilingula, lingula, and mandibular foramen. The antilingula was located anteriorly (4.28 mm and 3.59 mm) and above (1.99 mm and 8.52 mm) the lingula and mandibular foramen. The lingula was behind (0.69 mm) and above (6.53 mm) the mandibular foramen. Skeletal Class III was anterior and inferior to Class II and Class I in the antilingula, lingula, and mandibular foramen. Considering the correlations of landmarks, we found that the lingula was strongly correlated with the mandibular foramen on the X axis (r = 0.757) and Y-axis (r = 0.878). CONCLUSION: The antilingula is located anteriorly and above the lingula and mandibular foramen. The lingula is behind and above the mandibular foramen. The osteotomy line of orthognathic surgery can only be safely designed through actual measurement of the locations of the antilingula, lingula, and mandibular foramen.