Comparison of methods for detecting mandibular lingula and can antilingula be used in lingula mandibula detection?

TL;DR

This study examines anatomical landmarks in the mandible to improve surgical planning and reduce nerve damage risks during orthognathic procedures.

Contribution

The study provides new insights into the variability of antilingula types and their relationship with the lingula mandibula for safer surgical guidance.

Findings

The lingula mandibula position varies significantly depending on the type of antilingula.

Antilingula was undetectable in 26.25% of mandibular rami, suggesting it cannot be relied upon as a consistent reference point.

Preoperative CBCT evaluations help reduce the risk of inferior alveolar nerve injury during surgery.

Abstract

The aim of this study is to evaluate the relationship between anatomical reference points used during orthognathic surgery and to minimize the risks of iatrogenic neurovascular damage.

This retrospective study included cone-beam computed tomography (CBCT) images involving the mandible from patients who visited Recep Tayyip Erdoğan University Faculty of Dentistry between January 2018 and September 2023. The age range of the included individuals was set between 18 and 80 years. Horizontal and vertical distances between mandibular anatomical structures, such as the lingula mandibula (LM), mandibular foramen (MF), antilingula (AL), and surrounding structures were measured using CBCT software. Individuals with intraosseous pathology, insufficient image quality, or a history of surgical/orthodontic treatment were excluded from the study.

A total of 240 hemimandibles from 120 patients were analyzed (55.83% female, 44.17% male; mean age: 46.78 ± 15.30 years). Significant differences were identified in LM positions according to different AL types. The LM was found to be more inferior and posterior relative to hill and ridge type ALs, while it was more anterior relative to plateau type ALs. In 26.25% of mandibular rami, AL was not detected.

The position of the AL can serve as a guide in determining the osteotomy line during inferior vertical ramus osteotomy (IVRO). However, relying solely on AL as a reference point may increase the risk of inferior alveolar nerve (IAN) injury. Preoperative tomographic evaluations to determine the relationships among LM, MF, and AL can provide a safer approach in surgical planning, reduce complications, and help protect neurovascular structures.

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