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PubMed1986

The numb cheek syndrome: a sign of infraorbital neuropathy.

Three patients with skin cancer had numbness isolated to one cheek, in the distribution of the infraorbital nerve. Hypesthesia also involved the medial and lateral upper incisors and canine teeth, and adjacent gingiva, sparing the more posterior teeth and gums. The molar and premolar teeth and gums are innervated by the posterior and middle superior alveolar nerves; because these structures were spared, the pathologic process was localized to the infraorbital foramen, and we could exclude involvement of the maxillary division more proximally. In two patients, cheek numbness heralded recurrent squamous cell carcinoma. Analogous anatomy at the mental foramen should help distinguish intracranial leptomeningeal from local mandibular lesions producing isolated numbness of the chin.

Aged↗
PubMed2000

Anterior loop of the mental canal: an anatomical-radiologic study.

This study sought to characterize the anatomical dimensions of the anterior mental loop and to determine the accuracy of conventional radiographs in identifying its presence and dimensions. The study group consisted of 46 hemimandibles fixed in formalin. Radiographs of the area between the mental foramen and the midline were obtained and evaluated for each hemimandible, followed by dissection and physical examination of the same area. Anatomically, an anterior loop of the mental nerve was observed in only 13 hemimandibles (28%). The anterior extension of the loop ranged from 0.4 to 2.19 mm. No correlation was found between the radiographic image and the anatomical shape of the loop. Of the radiographically diagnosed loops, 40% were not seen in anatomical examination. In cases with a false radiologic loop, a correlation was found between the diameter of the origin of the incisive canal and the radiologic interpretation of the loop. The radiologic appearance or diagnosis of the anterior mental loop in cadaver mandibles does not disclose the true ramification of the inferior alveolar nerve to the mental and incisive nerve.

Cadaver↗
PubMed1997

Lower lip paraesthesia following restoration of a second premolar tooth. Case report.

A forty year old female patient developed paraesthesia of the right side of her lower lip following the placement of an extensive pin-retained amalgam restoration in her lower right second premolar tooth. Radiographs indicated that the mental foramen was close to the apex of this tooth and it was assumed that postoperative pulpitis and periapical inflammation had caused the paraesthesia through the effects of pressure on the mental nerve. The paraesthesia resolved following endodontic treatment of the lower second premolar tooth and the patient has had no further signs or symptoms.

Adult↗
PubMed1984

[Biomorphosis of the mandible].

Described is the postnatal development of the mandible. Estimated are the changes of the basal-angle, gonion -angle, thickness of mandibulae , the postnatal growth of the corpus and ramus mandibulae, the difference of hight between processus coronoideus in equilibrium with caput mandibulae and the width of processus coronoideus and ramus mandibulae. Included are distances of the foramen mentale and the direction of this short canal, the angle of the chin, the linea obliqua , the antilingula and on the medial side of the mandible, the linea mylohyoidea and sulcus mylohyoideus also position and form of foramen mandibulae including the lingula. Measured is the direction of ramus mandibulae, the largest distance between both rami and the distance between the apex of the coronoid process and the outborder of the caput mandibulae. The results are discussed with thoughts of early researchers and some remarks are made to canalis mandibulae.

Adolescent↗
PubMed1998

Morphologic effects of glycerol on the mental nerve.

OBJECTIVES: In recent years, injection of pure glycerol has been used successfully for the treatment of trigeminal neuralgia. However, the mode of action of this therapy remains unclear. The present experiment was undertaken to examine histologically the morphologic changes produced by extraneural injections of pure glycerol into the dog mental nerve. STUDY DESIGN: Under direct vision, glycerol was injected extraneurally into the mental foramen on one side of the lower jaw of each of nine dogs. Physiologic saline solution was the control on the contralateral side of each animal. Animals were killed at 1, 3, and 7 days after the application of glycerol, and the mental nerve specimens were examined by light microscopy. RESULTS: Results showed that extraneural application of pure glycerol in the vicinity of the dog mental nerve is not associated with structural changes. No signs of nerve degeneration or other morphologic changes were observed for any of the experimental and control specimens in any of the time intervals studied. CONCLUSIONS: It can be concluded that despite the encouraging clinical results related to extraneural application of pure glycerol for treatment of trigeminal neuralgia, glycerol produces its effect without inducing any morphologic or destructive changes in the peripheral nerve. A probable explanation of the temporary clinical effectiveness of glycerol in relieving trigeminal neuralgia is discussed.

Animals↗
PubMedDate not supplied

Dental radiology and oral pathology.

This article represents an overview of normal and pathological findings of the oral structures for the practicing radiologist. Some of the disease processes discussed are of dental etiology, whereas others are manifestations of systemic diseases. Normal tooth development is described followed by an overview of radiolucent, radiopaque, and mixed lucent-opaque lesions. In the radiolucent category, normal anatomical landmarks of the jaws include the mental foramen, manidbular canal, incisive canal and maxillary sinuses. Other lucencies that represent normal structures or variations include developing tooth buds and root apices, healing dental extraction sites, prominent submandibular fossae and nutrient canals. In the radiopaque category, normal anatomical landmarks of the jaws include the genial tubercle, mental ridge, external oblique ridge, walls of the submandibular canal, walls of the maxillary sinus, nasal septum, stylohyoid ligament, and zygomatic process. Other opacities that represent normal structures or variations include dental restoration material, dental endodontic material, retained roots, sialoliths, salivary duct calculi, calcified lymph nodes, recent extraction sites, hypercementosis, and foreign bodies. Pathological entities which present radiographically as lucencies, opacities, and mixed lucent-opaque areas include inflammatory lesions, cysts, fibro-osseous disease, benign neoplasms, malignant neoplasms, and lesions secondary to metabolic disorders.

Humans↗
PubMed2000

[Splenic natural killer cell activity is suppressed by ligation of unilateral mental nerve in rats].

It has been reported that surgical procedures and postoperative pain suppress immune activities of the patient. But it is not clear if chronic pain in a small area affects immune activities. We prepared rats with chronic neuralgia of the mental branch originating from the mandibular nerve (a division of the trigeminal nerve) and examined the change of splenic NK-cell activity. Surgical procedures to prepare rat models for the study were as follows: one mental nerve was exposed and ligated at the mental foramen in order to create hypersensitivity in the ipsilateral innervated area. Splenic NK-cell activity 3 weeks after the surgery was reduced significantly in the operation group than that of the sham-operation group and the non-operated control group. The result suggests that the immune functions are remarkably affected by chronic pain evoked in a limited area such as the area innervated by the mental nerve.

Animals↗
PubMed1999

Burkitt's lymphoma presenting as lower lip paraesthesia in a 24 year old Nigerian. Case report.

An unusual case of stage D Burkitt's lymphoma in a 24 year old Nigerian female undergraduate is reported. There was a four month history of left lower lip paraesthesia followed three months later by a slowly progressive 'pimple-sized' nodular mandibular swelling arising from the mental foramen region. A full-blown, rapidly developing abdominal mass manifested only three weeks after a biopsy of the mandibular swelling. Aspiration of the latter and a histologic report of the mandibular mass confirmed Burkitt's lymphoma. The patient responded very well to appropriate chemotherapy. Clinicians should not overlook insidious jaw swellings in any adult residing in the endemic zone of Burkitt's lymphoma, in view of the fact that successful therapy is dependent on early diagnosis. Mental nerve paraesthesia is very rarely seen in Burkitt's lymphoma.

Abdominal Neoplasms↗
PubMed2001

Neurosensory function and implant survival rate following implant placement with nerve transpositioning: a case study.

In patients with extensive bone resorption, implant placement posterior to the mental foramen is a problematic surgical procedure. This paper reports the results in 6 patients (aged 20-61) with edentulous areas in the posterior part of the mandible, in whom 26 Nobelpharma implants were placed, including 17 with transposition of the inferior alveolar nerve allowing the use of implant fixtures of at least 10 mm in length. Subsequent neurosensory function, based on British Medical Research Council definitions, and implant survival rate were examined. In all cases, postoperative numbness occurred in the lower lip and mental area. Three years after surgery, while one patient had completely recovered neurosensory function, five patients still experienced partial numbness, although this was not perceived as a problem by those patients. The implant survival rate was 100% approximately three years after surgery. The results suggest that a higher implant survival rate is likely when longer fixtures are used, but this is also more likely to lead to slight long-term neurosensory dysfunction.

Adult↗
PubMed1997

Innervation of the mandibular incisors by the mental nerve.

PURPOSE: This study tested the hypothesis that some sensory innervation to the lower incisor teeth comes from reentry of the terminal branches of the mental nerve through the labial plate of the anterior mandible. PATIENTS AND METHODS: Ten cadaveric heads (20 sides) were dissected and studied to determine whether the mental nerve crossed the midline or reentered the labial plate. Using careful dissection, the most posterior branch of the nerve was exposed from its point of emergence at the mental foramen to its insertions, and any entries into the labial plate were recorded and photographed. RESULTS: Three of 20 (15%) specimens showed unequivocal evidence of nerve reentry into the labial plate. Five specimens displayed strong evidence of nerve fibers reentering the plate, but these were too fragile to be dissected through the periosteum without breaking. In 12 of 20 (60%) specimens, there were no branches identified that reentered the bone plate. Of the eight specimens showing evidence of reentry, four had substantial midline crossover. CONCLUSIONS: The finding that branches of the mental nerve may reenter the labial plate to supply the lower incisors explains the phenomenon of crossover innervation from the contralateral mental nerve and the fact that a labial infiltration injection will anesthetize the lower incisor teeth.

Anesthesia, Dental↗
PubMed1975

[Determination of the individual-optimal occlusion height in the edentulous mouth].

Foramen ovale, foramen mandibulae and foramen mentale, as shown in lateral radiographs of human cadaver heads bisected in the median-sagittal plane, can be placed simultaneously in every position of the mandible on the logarithmic spiral line devised by M. Moss. The individually optimal vertical dimension is that position of the mandible in which the foramina occupy the most central position on this spiral line; abduction and adduction of the mandible from this position cause a shift of the foramina to the periphery of the spiral line. Geometrically, loss in vertical dimension due to edentia can be computed from changes of the mandibular angle. Geometrical relationships were also shown between the distance from the foramen ovale to the foramen mandibulae, and other directly measurable distances on lateral cephaloradiographs.

Cadaver↗
PubMed2002

Patterns of emergence of the human mental nerve.

This study investigated the path of emergence of the mental nerve in a number of human population groups. Skeletal material comprised 117 Negro skulls (53 males), 114 caucasoid skulls (62 males) and 100 pre-contact Maori skulls (70 males). In each case, the path of emergence was classified into posterior, anterior, right-angled or multiple. Those cases with severely resorbed alveolar ridges that made classification difficult were excluded from the study. Additionally, 56 cadaveric mandibles were examined, in which an osteotomy of 1cm was made on either side of the mental foramen to expose the nerve. The most common pattern of emergence in caucasoids and Maoris was a posterior direction (86.7% of caucasoid males, 90.2% of caucasoid females; 85.5% of Maori males, 93.1% of Maori females). In Negroes the most common pattern was a right-angled path of emergence (45.8% of males, 45.0% of females), with this difference between population groups being statistically significant (Pearson's chi(2): males=23.4, females=45-97; P<0.01). Multiple foramina were rare, with the highest incidence being in Maori and Negro males. Cadaveric data supported the findings of the skeletal investigation, with the dominant emergence recorded as posteriorly directed (80.7% of males, 86.6% of females). It was concluded that while the traditionally accepted ontogenetic explanation for the inclination of the mental nerve might be applicable to caucasoids and Maoris, it fails to explain the observed right-angled emergence pattern in Negroes. Hence, the nerve's emergence might be genetically, rather than functionally, determined. The study did not show a measurable anterior loop in the emergence of the mental nerve that would have any significant impact on treatment planning for implants in the anterior mandible.

Aged↗
PubMed1976

The remodeling of the edentulous mandible.

In a sample of mandibles having complete or nearly complete loss of dentition, the left half of each mandible was serially sectioned. The entire perimeter of each section was analyzed for the distribution of resorptive and depository periosteal surfaces, and from this information, the fields of remodeling were mapped for the mandible as a whole. The most common patterns of combined resorption-deposition and the range of variations were then determined. The over-all distribution of remodeling fields in the edentulous mandible differs markedly from that in the young, growing mandible. In most of the edentulous specimens, the surface of the basal bone on both the medial and lateral sides of the corpus is of a depository nature. The overlying alveolar regions on both the lingual and buccal sides, however, are characteristically resorptive. Significantly, the placement of the reversal line between the alveolar resorptive and the basal depository areas is much lower (i.e., at the level of the mental foramen) on the buccal side. Except for its inferior part, the lateral side of the ramus tends to be largely resorptive in character, and the posterior half of the lingual side also tends to be resorptive. Unlike the child's mandible, the posterior border of the ramus is resorptive, and the posteroanterior dimension of the ramus (not the whole mandible) becomes reduced and narrowed in conjunction with resorption along the anterior border. However, the amount removed from the anterior ramus is actually added to the dimension of the corpus, which becomes longer. Further, removal from the posterior ramus border does not affect the over-all length of the mandible unless condylar reduction is also involved. Also, over-all arch length is not decreased, because the surface of the mental protuberance is retained as a depository type of field (or at least does not become actively resorptive). The corpus-ramus angle (not gonial angle) is increased in the antegonial region. Because of the opening of this angle, over-all mandibular length as well as arch length is increased. In about half of the specimens, arch width was not decreased, because the lateral side of the corpus is usually of a depository nature. Notching of the anterior side of the condylar neck and the inferior part of the anterior ramus border is associated with resorptive fields in these regions, changes that are presumed to be a consequence of pressure contacts made with the articular tubercle and the maxillary tuberosity, respectively, in conjunction with a forward rotation of the whole mandible. The inferior direction of corpus realignment relative to the basal part of the ramus also increases the notching effect in the antegonial region, an effect augmented by the presence of the resorptive field in the notch itself. Certain specific variations commonly occur in several major regions of the mandible on both the lateral and medial sides...

Alveolar Process↗
PubMedDate not supplied

Morphometric analysis of mandibular canal: clinical aspects.

Results of morphometric analysis of the mandibular canal (MC), carried out on 105 conserved mandibles, 70 being dentate and 35 edentate, was performed. The analysis was carried out on consecutive sections, at mutual intervals of 0.5 cm. In the mandibular ramus sections were carried out obliquely, approximately in the frontal plane, and horizontally, from mandibular foramen to the lowest region of the vertical part of the MC (all together two sections). In the mandibular corpus, consecutive transversal sections were carried out between existing teeth, or at mutual intervals of 0.5 cm in edentate regions. The obtained results pointed out the very close relationship between the MC and lingual cortical plate of the mandibular ramus. In its horizontal part, the average diameter of the MC was 2.6 mm. It was situated more lingually in the molar region; towards the front, it approached the vestibular cortical plate, being closest to it in the region of the second premolar. Similar relationships of the MC and both cortical plates existed in edentate jaws. Relationships of the MC and tooth root apices varied; however, the MC was closest to the apices of the third molar. Mesially from the mental foramen, a clearly defined incisive canal was present in 92% of the dentale mandibles, but only in 31% of the edentate ones. The nearest to the incisive canal was the apex of the first premolar. The authors point out the importance of presented results in everyday practice, especially in oral and maxillofacial surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1996

Lateral mandibular reconstruction using soft-tissue free flaps and plates.

OBJECTIVE: To assess the outcome of patients who are undergoing reconstruction of segmental lateral mandibular defects by using soft-tissue free flaps combined with mandibular reconstruction plates. DESIGN: Retrospective case series of 15 patients who were undergoing primary reconstruction of mandibular segments posterior to the mental foramen, resulting from treatment of head and neck cancer. All patients received either preoperative or postoperative radiation therapy. SETTING: Academic tertiary care referral center. INTERVENTIONS: Fourteen patients had mandibular continuity restored by using the titanium hollow screw reconstruction plate system, and 1 patient received a stainless steel mandibular reconstruction plate. Associated soft-tissue defects were repaired by using radial forearm (n = 11), rectus abdominis (n = 2), scapular and parascapular (n = 1), or lateral arm (n = 1) free flaps. MAIN OUTCOME MEASURES: Early and delayed complications. RESULTS: All 15 microvascular free tissue transfers were successful. Early complications were minor and occurred in 5 (33%) of 15 patients. One patient in whom the titanium hollow screw reconstruction plate system had been used experienced a fracture at 15 months after reconstruction. Three patients experienced delayed external plate exposure between 7 and 15 months after primary oromandibular reconstruction. Patients who experienced delayed external plate exposure required secondary reconstruction with a vascularized bone-containing free flap. The overall rate of delayed reconstructive failure was 40% in patients who were followed up for a minimum of 1 year. CONCLUSIONS: For patients who are undergoing free flap reconstruction of lateral mandibulectomy defects, the technique that used soft-tissue free flaps combined with mandibular reconstruction plates has been abandoned in favor of using vascularized bone-containing free flaps or a combination of free flaps to achieve optimal long-term results.

Adult↗
PubMed2000

Intraoperative monitoring of the inferior alveolar nerve during mandibular sagittal-split osteotomy.

In order to evaluate the risk of nerve injury and to prevent iatrogenic damage at different stages of bilateral sagittal-split osteotomy (BSSO) of the mandible, we monitored the function of the inferior alveolar nerve (IAN) continuously on both sides in 13 orthognathic patients undergoing BSSO. The IAN was stimulated at the mental foramen with two monopolar needle electrodes fixed to the dental splint, and the orthodromic sensory nerve action potentials (SNAP) of the IAN were recorded with a silver-wire electrode inserted near the oval foramen on each side. The latencies, amplitudes, and sensory nerve conduction velocities at baseline, after medial opening, sawing, splitting, eventual manipulation, and fixation of the mandible were analyzed. The monitoring method functioned technically well in 25 of 26 nerves. Both the surgical technique and the duration of medial opening had conspicuous effects on the function of the IAN, which led us to modify the medial approach. When finer instruments were used for retraction and the duration of medial opening was shortened to less than 10 min, the SNAP of the IAN was always preserved at this stage. Monitoring of the IAN also prevented nerve injury during splitting and fixation. This technique for intraoperative monitoring of the IAN seems to be a feasible and promising tool for objective evaluation of intraoperative events and for prevention of nerve injury during BSSO.

Adolescent↗
PubMed2001

Occurrence of neanderthal features in mandibles from the Atapuerca-SH site.

Analysis of variation and distribution of evolutionary novelties is meaningful in understanding evolutionary processes. The mandible, as a morphological complex, comprises a large number of derived Neanderthal features. The present study investigates whether the features usually considered as European lineage apomorphies evolved independently; the occurrence of these features is studied in the mandibles from the Sima de los Huesos (SH) site (Atapuerca, Spain). For comparative purposes, a large sample of Neanderthal mandibles as well as older fossil Homo specimens have been used for the study. Chi-square tests were employed to test for independence. The SH mandibles present a set of features that clearly show the basic architecture of the Neanderthal mandible. A highly significant association is detected in the variation of the position of the mental foramen, the lateral prominence, and the anterior marginal tubercle, as well as in the development of retromolar space. However, a much weaker association is detected in the features of the internal aspect of the mandible, with a few exceptions. Features of the external aspect of the mandible occur chronologically earlier than those observed in the internal aspect. The hypothesis that two distinct and consecutive morphological processes have driven the emergence of the European lineage throughout the Middle Pleistocene is proposed. A first transformation affects the mandible by means of backwards displacement of the structures located at the external aspect, as well as the position of the condyle. A second process would modify the features of the internal aspect of the mandible, in which the relief of the masseteric and pterygoid fossae are affected, in association with a spatial rearrangement of the corpus and ramus. Analyzed individually, some of the considered features may be questioned as Neanderthal apomorphies (Trinkaus,1993; Franciscus and Trinkaus, 995); however, the joint occurrence of many of them suggests that the complex is an evolutionary novelty.

Adolescent↗
PubMed1992

New species of bushbaby from the middle Miocene of Maboko Island, Kenya.

A mandible recovered from ca. 15 million year old deposits of Maboko Island, Kenya, represents the first bushbaby known from the middle Miocene. The specimen is from a new species of Komba, a genus previously known from early Miocene occurrences in western Kenya and northeastern Uganda. Komba is revised, with emended diagnoses proposed for the genus, type-species, and referred species. Komba sp. nov. is distinguished by its larger size and differences of molar cusp acuity, buccal cingulum expression, and mental foramen configuration. Contrary to previous opinion, species of Komba probably diverged prior to the last common ancestor of extant Galaginae, and it is unlikely that they represent early stages of living bushbaby species lineages. Although contemporary Progalago is widely regarded as a galagine, aspects of upper molar, lower premolar, and mandibular corpus morphology indicate that it is more closely related to lorisines. Unlike the greater success currently enjoyed by bushbabies, lorisines were more diverse and almost as abundant as galagines in the early Miocene of eastern Africa.

Animals↗