Citation Information :
Tungkeeratichai J, Leelapatharaphan N, Iamsudjai Y, Panyaping T. Anatomical Study of the Mandibular Canal: The Safe Surgical Landmarks for Mandibular Contouring Surgery. Int J Otorhinolaryngol Clin 2023; 15 (3):128-131.
Background: Mandibular contouring surgery is a common facial plastic surgery in Asia. The aim of this study was to evaluate the course of intraosseous inferior alveolar nerve within the mandibular canal in Thai population through three-dimensional computed tomography (CT) to find the safe surgical landmarks for mandibular contouring surgery.
Materials and methods: This was a retrospective study in 200 patients who underwent computed tomographic assessment of head and neck region at the Faculty of Medicine, Ramathibodi Hospital, Mahidol University from January 2010 to December 2015. The inferior alveolar nerve was identified and traced along the mandibular canal from a three-dimensional image slice, and then the reconstruction of 3D images was performed. The oblique line, the alveolar arch line, the gonion, and O point were identified. Afterwards, the horizontal, oblique, and vertical distances were defined and measured. Comparison of these distances between each side was also analyzed.
Results: The mandibular canal was far away from the posterior border of ramus for 17.58–17.62 mm in male, and 15.61–15.68 mm in female. It was far away from the gonion for 25.67–25.75 mm in male, and 22.73–22.77 mm in female. It was far away from the inferior border of mandibular body for 16.62–16.78 mm in male, and 15.75–15.84 mm in female. The statistical analysis showed no significant difference in all distances between each side in both male and female groups.
Conclusion: A safe surgical landmark for angle mandible reduction is at a width less than 25 mm from the gonion in Thai men and 22 mm in Thai women.
Beckers HL. Masseteric muscle hypertrophy and its intraoral surgical correction. J Maxillofac Surg 1977;5(1):28–35. DOI: 10.1016/s0301-0503(77)80072-6.
Roncevic R. Masseter muscle hypertrophy. Aetiology and therapy. J Maxillofac Surg 1986;14(6):344–348. DOI: 10.1016/s0301-0503(86)80322-8.
Baek SM, Kim SS, Bindiger A. The prominent mandibular angle: preoperative management, operative technique, and results in 42 patients. Plast Reconstr Surg 1989;83(2):272–280. PMID: 2911627.
Deguchi M, Iio Y, Kobayashi K, et al. Angle-splitting ostectomy for reducing the width of the lower face. Plast Reconstr Surg 1997;99(7):1831–1839. DOI: 10.1097/00006534-199706000-00005.
Lee Y, Kim JH. Mandibular contouring: A surgical technique for the asymmetrical lower face. Plast Reconstr Surg 1999;104(4):1165–1171; discussion 1172–1163. PMID: 10654760.
Yang DB, Song HS, Park CG. Unfavorable results and their resolution in mandibular contouring surgery. Aesthetic Plast Surg 1995;19(1): 93–102. DOI: 10.1007/BF00209317.
Baek RM, Han SB, Baek SM. Surgical correction of the face with the square jaw and weak chin: Angle-to-chin bone transfer. Plast Reconstr Surg. 2001;108(1):225–232. DOI: 10.1097/00006534-200107000-00036, discussion 232.
Yang DB, Park CG. Mandibular contouring surgery for purely aesthetic reasons. Aesthetic Plast Surg 1991;15(1):53–60. DOI: 10.1007/BF02273834.
Han K, Kim J. Reduction mandibuloplasty: ostectomy of the lateral cortex around the mandibular angle. J Craniofac Surg 2001;12(4): 314–325. DOI: 10.1097/00001665-200107000-00004.
Satoh K. Mandibular contouring surgery by angular contouring combined with genioplasty in orientals. Plast Reconstr Surg 1998;101(2):461–472. DOI: 10.1097/00006534-199802000-00035.
Kyutoku S, Yanagida A, Kusumoto K, et al. The gonial angle stripper: an instrument for the treatment of prominent gonial angle. Ann Plast Surg 1994;33(6):672–676. DOI: 10.1097/00000637-199412000-00022.
Baek SM, Baek RM, Shin MS. Refinement in aesthetic contouring of the prominent mandibular angle. Aesthetic Plast Surg 1994;18(3): 283–289. DOI: 10.1007/BF00449796.
Kim SK, Han JJ, Kim JT. Classification and treatment of prominent mandibular angle. Aesthetic Plast Surg 2001;25(5):382–387. DOI: 10.1007/s002660010150.
Kane AA, Lo LJ, Chen YR, et al. The course of the inferior alveolar nerve in the normal human mandibular ramus and in patients presenting for cosmetic reduction of the mandibular angles. Plast Reconstr Surg 2000;106(5):1162–1176. DOI: 10.1097/00006534-200010000-00029; discussion 1175–1166.
Lo LJ, Wong FH, Chen YR. The position of the inferior alveolar nerve at the mandibular angle: An anatomic consideration for aesthetic mandibular angle reduction. Ann Plast Surg 2004;53(1):50–55. DOI: 10.1097/01.sap.0000112282.94585.44.
Stein W, Hassfeld S, Muhling J. Tracing of thin tubular structures in computer tomographic data. Comput Aided Surg 1998;3(2):83–88. DOI: 10.1002/(SICI)1097-0150(1998)3:2<83::AID-IGS5>3.0.CO;2-G.
Zoud K, Doran GA. Microsurgical anatomy of the inferior alveolar neurovascular plexus. Surg Radiol Anat 1993;15(3):175–179. DOI: 10.1007/BF01627698.
Carter RB, Keen EN. The intramandibular course of the inferior alveolar nerve. J Anat 1971;108(Pt 3):433–440. PMID: 5575310.
Haribhakti VV. The dentate adult human mandible: an anatomic basis for surgical decision making. Plast Reconstr Surg 1996;97(3):536–541. DOI: 10.1097/00006534-199603000-00006; discussion.
Svane TJ, Wolford LM, Milam SB, et al. Fascicular characteristics of the human inferior alveolar nerve. J Oral Maxillofac Surg 1986;44(6): 431–434. DOI: 10.1016/s0278-2391(86)80006-4.
Wadu SG, Penhall B, Townsend GC. Morphological variability of the human inferior alveolar nerve. Clin Anat 1997;10(2):82–87. DOI: 10.1002/(SICI)1098-2353(1997)10:2<82::AID-CA2>3.0.CO;2-V.
Poirot G, Delattre JF, Palot C, et al. The inferior alveolar artery in its bony course. Surg Radiol Anat 1986;8(4):237–244. DOI: 10.1007/BF02425073.
Fujita A, Shintani S. Computed tomographic analysis of the mandibular body and ramus in Japanese patients: Relevance to bone harvesting from the mandibular ramus. Implant Dent 2015;24(4): 402–406. DOI: 10.1097/ID.0000000000000271.
Haas LF, Dutra K, Porporatti AL, et al. Anatomical variations of mandibular canal detected by panoramic radiography and CT: A systematic review and meta-analysis. Dentomaxillofac Radiol 2016;45(2):20150310. DOI: 10.1259/dmfr.20150310.
Tiwari P, Chin DH, Cutting CB, et al. The course of the inferior alveolar nerve in craniofacial microsomia: virtual dissection using three-dimensional computed tomography image analysis. Plast Reconstr Surg 2002;109(5):1513–1521. DOI: 10.1097/00006534-200204150-00005.
Kamburoğlu K, Kiliç C, Ozen T, et al. Measurements of mandibular canal region obtained by cone-beam computed tomography: A cadaveric study. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics 2009;107(2):e34–e42. DOI: 10.1016/j.tripleo.2008.10.012.
Massey ND, Galil KA, Wilson TD. Determining position of the inferior alveolar nerve via anatomical dissection and micro-computed tomography in preparation for dental implants. Journal (Canadian Dental Association). 2013;79:d39. PMID: 23920072.