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Table of Contents
ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 1  |  Page : 20-24

Detection of lingual vascular canal by cone-beam computed tomography


1 Department of Oral Medicine and Radiology, Rishiraj College of Dental Science and Research Center, Bhopal, Madhya Pradesh, India
2 Department of Oral and Maxillofacial Surgery, Rishiraj College of Dental Science and Research Center, Bhopal, Madhya Pradesh, India
3 Department of Community Dentistry, Rishiraj College of Dental Science and Research Center, Bhopal, Madhya Pradesh, India

Date of Web Publication25-Jul-2018

Correspondence Address:
Dr. Preeti Bhadouria
Department of Oral Medicine and Radiology, Rishiraj College of Dental Science and Research Center, Gandhi Nagar, Bhopal - 462 036. Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdi.jdi_17_17

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   Abstract 

Objective: The purpose of the present study is to assess the location and size of lingual vascular canal using cone-beam computed tomography (CBCT).
Materials and Methods: A retrospective analysis of cone beam CT (CBCT) scan images of 100 patients was done at CBCT centre in Bhopal, India. Patients undergoing CBCT scans for implant placement were included in this study. CBCT machine used was Sirona Orthophos SL (Sirona, Germany) having flat panel detector. Scan parameter adjusted were 70Kv and 8mA, having an exposure time of 14 seconds with voxel size of 8*8mm and spatial resolution of 110μm. The frequency, number, and location of the lingual vascular canals were evaluated. In addition, the exact location of each canal was obtained by measuring the distance to the canal from the inferior border of the mandible. The diameter of the canal was measured midway of the canal wall [Figure 1] and [Figure 2]. Statistical analysis was performed using SPSS software to determine the frequency, location, and number of the canal.
Study Design: This study analyzed 100 cbct scans of patients between 20-60 years enrolled at a cbct centre in bhopal, india. this image were acquired using sirona's orthophos SL. two oral and maxillofacial radiologists examined all images to analyzed the location and distance of lingual vascular canal with respect to gender and age.
Results: About 100 patients (male = 49 and female = 51) demonstrated the presence of lingual vascular channels (LVC) with only one patient showing three canals. Hence, the maximum number of single and double lingual vascular canal was present in female patients. The mean distance from the inferior border of mandible was 9.39 ± 3.28 mm in males. There was no significant difference regarding the location of the lingual vascular canal and its presence and absence. Gender-wise distribution of lingual vascular canal in male patient was 49, and in female patients, it was 51.
Conclusion: CBCT provides adequate information regarding number and size of lingual vascular canal, which is an important anatomical structure in mandibular anterior region.

Keywords: Computed tomography, cone-beam computed tomography, lingual vascular canal


How to cite this article:
Bhadouria P, Payak AS, Jaju PP, Shrivastava A. Detection of lingual vascular canal by cone-beam computed tomography. J Dent Implant 2018;8:20-4

How to cite this URL:
Bhadouria P, Payak AS, Jaju PP, Shrivastava A. Detection of lingual vascular canal by cone-beam computed tomography. J Dent Implant [serial online] 2018 [cited 2018 Dec 10];8:20-4. Available from: http://www.jdionline.org/text.asp?2018/8/1/20/237585


   Introduction Top


Mandibular anterior region is one of the most common areas for surgical procedure. Dental implant placement has become an integral part of comprehensive treatment plans for dental rehabilitation for edentulous patients. A thorough patient assessment is a prerequisite for adequate treatment planning and placement of dental implants. Dental imaging is an important tool to accomplish this task.[1]

Some of the common problems encountered during dental implant surgery include insufficient bone volume, neurosensory disturbances, and hemorrhage due to injury to neurovascular bundles during dental implant placement in severely resorbed arches.[1]

One of the most frequent accidental complications that may occur during surgical procedures in the mandibular interforaminal region is a neurosensory disturbance in the chin and lower lip. This complication occurs when important structures such as the mental foramen, the anterior loop of the inferior alveolar nerve, and the incisive canal are not properly identified and protected.[2]

The use of appropriate imaging techniques is, therefore, essential to enable the accurate identification and location of these vital structures, avoiding potential injuries when surgical procedures are performed in the mandibular interforaminal region, including insertion of dental implants, mentoplasty, and rehabilitation after trauma. Cone-beam computed tomography (CBCT) is a relatively new imaging modality that provides a detailed evaluation of important bony structures.

Considering the importance of this region, the present study was conducted to assess the number and location of canals using CBCT.


   Materials and Methods Top


A retrospective analysis of CBCT scan images of 100 patients was done at CBCT center in Bhopal, India. Patients undergoing CBCT scans for implant placement were included in this study. CBCT machine used was Sirona Orthophos SL (Sirona, Germany) having flat panel detector. Scan parameter adjusted was 70Kv and 8 mA, having an exposure time of 14 s with voxel size of 8 mm × 8 mm and spatial resolution of 110 μm.

The frequency, number, and location of the lingual vascular canals were evaluated. In addition, the exact location of each canal was obtained by measuring the distance to the canal from the inferior border of the mandible. The diameter of the canal was measured midway of the canal wall [Figure 1] and [Figure 2]. Statistical analysis was performed using SPSS 21.0 software (IBM, Armonk, NY, United states of America) to determine the frequency, location, and number of the canal.
Figure 1: Measurement of location of single and double lingual vascular canal (location was calculated as “distance from the inferior border of mandible”)

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Figure 2: Measurement of dimension of single or double lingual vascular canal

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Inclusion criteria

  • Dentate or edentulous Indian patients between the ages 20 and 60 years
  • Healthy, medically compromised or even those previously radiated patients but not involving the interforaminal region of the mandible.


Exclusion criteria

  • Patients with a history of trauma or pathology to the mandible
  • Syndromic patients and patients with congenital disorders
  • Patients of mixed racial origins
  • Patients with existing pathological disorder at mandible such as cysts, tumors, osteomyelitis, and fibrous dysplasia
  • The reformatted CBCT images, which appear distorted or blurred due to patients' movements.



   Results Top


This study included 49 male and 51 female patients. For male, the average age was 18 years, while for female, the average age was 21 years. The canal was visible clearly in the axial and paraxial images. Lingual vascular channels (LVCs) were detected in 100% of patients (male = 49 and female = 5). The most common location found for these vascular canals was in midline of the mandible with 75% of positive cases.

Distance/location of lingual vascular canal among study participants according to age groups was done and it was observed that the distance of lingual vascular canal was maximum in age groups 31–40 years with a mean value of 9.45 mm ± 3.49 mm, while the location of lingual vascular canal was minimum in the age group of 51–60 with mean value of 9.37 mm ± 3.05 mm [Figure 1] and [Table 1].
Table 1: Comparison of location of lingual vascular canal among study subjects according to age groups *Location was calculated as “distance from the inferior border of mandible to the inferior border of lingual vascular canal”

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Diameter of lingual vascular canal was observed as 0.61 mm ± 0.78 mm (mean ± standard deviation [SD]) in male and 0.69 mm ± 1.04 mm (mean ± SD) in female. Maximum diameter of lingual vascular canal was observed in females [Figure 2] and [Table 2].
Table 2: Comparison of diameter of lingual vascular canal among study participants according to gender

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The presence of single, double, or triple lingual vascular canal among study participants was also studied. According to age groups, it was observed that single lingual vascular canal was maximum in the age group of 51–60 years, while the double lingual vascular canal was maximum in the age group of 41–50 years and triple lingual vascular canal was also present in the age group of 31–40 years of total 100 patients [Table 3].
Table 3: Presence of single, double, and triple lingual vascular canal among study participants according to age groups

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Presence of single, double or triple lingual vascular canal among study subjects according to gender was also evaluated. It was observed that single, double and triple lingual vascular canal were present in 32, 16 and 1 number of males and 33, 18 and 0 numbers of females respectively. So the maximum number of single & double lingual vascular canal was present in female patients and one triple lingual vascular canal was present in a male patient [Table 4].
Table 4: Presence of single, double, and triple lingual vascular canal among study participants according to gender

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   Discussion Top


The mandibular interforaminal area is assumed to be a safe for implant insertion and is involved in many other surgical procedures. It is essential to understand the anatomy of the region for avoiding injuries to the neurovascular bundles.[3]

The assessment of location of anatomic structure such as LVC in the mandible is required while enterprising quality dental care which include implant surgery. VC is one of the most important anatomical structures that is often undetected in mandible.[3] A number of researchers have recommended that blood vessels and nerves could enter the lingual foramen. A number of researchers have recommended that blood vessels and nerves could enter the lingual foramen. Ennis, Suzuki and Sakai, McDonnell et al., Darriba and Mendonca– Cardad and Givol et al., assumed a vascular content being an anastomosis of the sublingual branch of right and left lingual arteries. The artery could be of sufficient size to provoke a hemorrhage intraosseously or in the connective soft tissue, which might be difficult to control. Sutton described the structures associated with the foramen as a neurovascular bundle.[4]

By Jaju and Jaju,[4] the most common location found for this vascular canal was in midline of the mandible (75%). In most patients, one canal was detected, while in single patient, two canals were detected (48–year-old female). Many imaging options have been recommended for implant treatment planning including intraoral radiography, conventional extraoral radiography, tomography, CT, and CBCT. However, neither buccolingual width nor angulation or assessment of the location of mandibular vital structure can be properly visualized on most traditional radiograph.[5]

In a study by Jaju and Jaju,[4] they found that lingual vascular canal was detected in 73.3% of patients (male = 34 and female = 21). Mathew AK, Shenai P, Chatra L, Rao PK, Prabhu RV, 15 patients were males and 15 patients were females, 63% showed the presence of lingual emerging vascular channels wherein 37% of them it was absent. Vascular channels were present among both the genders with slightly higher percentage seen in male population.

In our study, we found that the presence of single, double, and triple lingual vascular canals among study participants in different ages and genders. It was observed that single lingual vascular canal was maximum in the age group of 51–60 years, double lingual vascular canal was maximum in the age group of 41–50 years and triple lingual vascular canal was present in 31–40 years of age. Similarly, single, double, and triple lingual vascular canal was present in 32, 16, and 1 number of males and 33, 18, and 0 numbers of females, respectively. Statistically, no significant differences were observed in the presence of lingual vascular canals among various age groups and gender [Table 4].

A study done by Juodzbalys G (2010)[5] showed that 103 patients (90.35%) had at least one lingual vascular canal and 52 (45.61%) had multiple (two or three) canals. These results were similar to our study. As compared to our study, a marked difference was seen in gender distribution. Single vascular canal was found in 8% of males and 7% of females and double lingual vascular canal was found in 5% of males and 10% of females, which was much lower as compared to our study.

Similarly, in another study by Mathew et al.[6] showed the presence of only single vascular channel emerging through the lingual mandible in most population (84%) and only a few cases showed the presence of multiple channels (16%). In all the studies, there was no significant difference noticed.

In the present study, we also measured the diameters of lingual vascular canal. Maximum diameter was seen in the age group of 51–60 years with the mean value of 0.78 ± 1.33 (mean ± SD), while the diameter of lingual vascular canal was minimum in 20–30 years of age group with the mean value of 0.520 ± 0.037. Maximum diameter of lingual vascular canal observed in males was 0.61 ± 0.78 and that in females was 0.69 ± 1.04 (mean ± SD). Statistically, no significant difference for the diameter of lingual vascular canal was seen between different age groups and gender (MW = 190.000, P > 0.05) [Table 2].

In a study conducted by Gahleitner et al.[7] where 32 consecutive patients underwent preimplantation CT of the lower jaw, the mean diameter of the lingual vascular canals in the midline was 0.7 mm ± 0.3 (SD) (range: 0.4–1.5) and in both the premolar region was 0.6 mm ± 0.2 (range: 0.3 mm–1.2 mm). Similarly, Scaravilli et al.[8] found that the mean diameter of the lingual canals in the midline (MLC) was 0.8 mm ± 0. The direction of MLC progresses in an anterior and slightly caudal sense.[9] With age-related changes and osteoporotic factors, ossification surrounding the canal can decrease, thereby reducing the visibility of canal.[10] In our study, the diameter of lingual vascular canal in the midline was 0.20 ± 6.90 and there was maximum in 51–60 years of age because the maximum number of patient was present in this age group.

In our study, we compared the location of lingual vascular canal among study participants according to age groups. Location was calculated as “distance from the inferior border of mandible.” It was observed that the mean value of location/distance of lingual vascular canal in the age group of 31–40 years was 9.45 ± 3.49, and maximum distance of lingual vascular canal was observed as 9.39 ± 3.28 mm in males. There was no significant difference for location of lingual vascular canal between different age groups and gender (P > 0.05) [Table 1].

In a study by Jaju and Jaju,[4] the mean distance of the canal measured from the inferior border of mandible was 0.56 mm. The mean distance in males was 0.64 mm, while for females, it was 0.45 mm. The most common location found for these vascular canals was in midline of the mandible with 75% of positive cases. The results of this study were higher as compared to our study. Similarly by Scaravilli et al.[8] showed that the typical locations of median lingual vascular canal MLVC were in the MLC.

With age-related changes and osteoporotic factors, ossification surrounding the canal can decrease, thereby reducing the visibility of canal.[10] In addition, visibility of structures such as these is heavily dependent on image quality (resolution, contrast, etc.). The difference between studies in the literature and this study may be due to different scanners, different imaging protocols, and observer detection variability. Research should focus on looking at cases with hemorrhage problems and to see what clinical and radiological factors are associated with it, of which the presence of lingual canals may only be a small contributory factor.


   Conclusion Top


The presence of anatomical variations in the mandible is still frequently neglected. It is important to underscore that these variations can be identified in presurgical imaging examinations, permitting more accurate planning and contributing to successful treatment. Damage to the lingual artery in the mandibular anterior region is one of such complications. Since conventional radiographs may fail in the identification of variations, CBCT is of fundamental importance in this process. The results of this report demonstrate that CBCT is a useful tool for the detection of lingual vascular canal. It is essential to be aware of the possibility of these anatomical variations already when planning surgery and when viewing the preoperative radiological examination.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Kumar V, Satheesh K. Application of Cone Beam Computed Tomography (CBCT) in implant treatment planning. JSM Dent 2013;1:1-8.  Back to cited text no. 1
    
2.
Genú PR, Vasconcellos RJ, Oliveira BP. Analysis of anatomical landmarks of the mandibular interforaminal region using CBCT in a Brazilian population. Braz J Oral Sci 2014;13:303-7.  Back to cited text no. 2
    
3.
Parnia F, Moslehifard E, Hafezeqoran A, Mahboub F, Mojaver-Kahnamoui H. Characteristics of anatomical landmarks in the mandibular interforaminal region: A cone-beam computed tomography study. Med Oral Patol Oral Cir Bucal 2012;17:e420-5.  Back to cited text no. 3
    
4.
Jaju P, Jaju S. Lingual vascular canal assessment by dental computed tomography: A retrospective study. Indian J Dent Res 2011;22:232-6.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Juodzbalys G, Wang HL. Identification of the mandibular vital structures: Practical clinical applications of anatomy and radiological examination methods. J Oral Maxillofac Res 2010;1:e1.  Back to cited text no. 5
    
6.
Mathew AK, Shenai P, Chatra L, Rao PK, Prabhu RV. Computed tomographic assessment of lingual vascular channels in the mandible – An imaging study. South East Asian J Clin Res 2015;1:11-5.  Back to cited text no. 6
    
7.
Gahleitner A, Hofschneider U, Tepper G, Pretterklieber M, Schick S, Zauza K, et al. Lingual vascular canals of the mandible: Evaluation with dental CT. Radiology 2001;220:186-9.  Back to cited text no. 7
    
8.
Scaravilli MS, Mariniello M, Sammartino G. Mandibular lingual vascular canals (MLVC): Evaluation on dental CTs of a case series. Eur J Radiol 2010;76:173-6.  Back to cited text no. 8
    
9.
Cova M, Ukmar M, Bole T, Morra A, Lubin E, Pozzi Mucelli R, et al. Evaluation of lingual vascular canals of the mandible with computed tomography. Radiol Med 2003;106:391-8.  Back to cited text no. 9
    
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Gültekin S, Araç M, Celik H, Karaosmaoǧlu AD, Işik S. Assessment of mandibular vascular canals by dental CT. Tani Girisim Radyol 2003;9:188-91.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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