Three-dimensional analysis of mandibular lingula apex to guide the mandibular foramen location in North Indian population: a computed tomography study

Abstract

Purpose: Mandibular lingula apex (MLA) acts as an important landmark for identifying the site for injection of local anesthetics during inferior alveolar nerve block. The authors aimed to determine the three-dimensional position of MLA to guide clinician for inferior alveolar nerve block and surgical procedures.Methods: Computed tomography (CT) images of 100 MLAs from 50 patients (12 females, 38 males) aged between 16-85 years were evaluated. Distances and angles from MLA to different anatomic landmarks on mandibular ramus were measured. Pearson’s correlation was performed for the statistical comparisons.Results: The authors found that the shortest distance of MLA from ramus anterior, posterior, superior, inferior border and mandibular angle was 14.07 mm, 17.32 mm, 16.23 mm, 34.1 mm, and 30.9 mm respectively. The MLA was positioned nearly 1.63 mm behind the midpoint of the ramus horizontally and 8.94 mm above the midpoint vertically. Mandibular angle was 121.7 degree and MLA angle from inferior border was 87.74 degree. There was found no correlation between DLA and age and also there was strong positive correlation between DLA and height of ramus. A negative correlation was found between DLA and mandibular angle. Conclusion: The present study represents that CT provides reliable information about the position of MLA in relation to different anatomical landmarks of mandibular ramus which may help in successful and safe treatment procedures with reduced complications. MLA distance from anterior border of ramus will be more with increased ramus height and decreased mandibular angle and also vice versa, which may be helpful to give an accurate location of MLA during inferior alveolar nerve block procedure.