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Unilateral widening of the inferior alveolar nerve canal: a rare anatomic variant mimicking disease

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Abstract

We report a case of an asymptomatic healthy 49-year-old male patient with an incidental finding of enlargement of the right inferior alveolar nerve (IAN) canal (9 vs. 4 mm). After 2 years, follow-up magnetic resonance imaging (MRI) revealed no change in the findings. In addition, MR-based diffusion tensor imaging with tractography of the right and left mandibular nerves showed that the difference in size between the right and left nerves was caused by an increased number of nerve fibers in the right IAN. During the entire follow-up period of 4 years, the patient remained symptom-free. Therefore, we suggest that the enlargement in our patient was a pure anatomic variant. However, a multitude of conditions are known to produce the identical radiological appearance in conventional radiology, including benign and malignant tumors, vascular malformations, and inflammatory disorders. We describe these pathologies in more detail as well as the possibilities for examinations with different MRI sequences.

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References

  1. Kieser J, Kieser D, Hauman T. The course and distribution of the inferior alveolar nerve in the edentulous mandible. J Craniofac Surg. 2005;1:6–9.

    Article  Google Scholar 

  2. Olivier E. The inferior dental canal and its nerve in the adult. Br Dent J. 1928;49:356–8.

    Google Scholar 

  3. Juodzbalys G, Wang HL, Sabalys G. Anatomy of mandibular vital structures. Part II: mandibular incisive canal, mental foramen and associated neurovascular bundles in relation with dental implantology. J Oral Maxillofac Res. 2010;1:e3.

    Google Scholar 

  4. Williams LS, Schmalfuss IM, Sistrom CL, Inoue T, Tanaka R, Seoane ER, et al. MR imaging of the trigeminal ganglion, nerve, and the perineural vascular plexus: normal appearance and variants with correlation to cadaver specimens. AJNR Am J Neuroradiol. 2003;24:1317–23.

    PubMed  Google Scholar 

  5. Becker M, Kohler R, Vargas MI, Viallon M, Delavelle J. Pathology of the trigeminal nerve. Neuroimag Clin N Am. 2008;18:283–307.

    Article  Google Scholar 

  6. Borges A, Casselman J. Imaging the trigeminal nerve. Eur J Radiol. 2010;74:323–40.

    Article  PubMed  Google Scholar 

  7. Vargas MI, Viallon M, Nguyen D, Delavelle J, Becker M. Diffusion tensor imaging (DTI) and tractography of the brachial plexus: feasibility and initial experience in neoplastic conditions. Neuroradiology. 2010;52:237–45.

    Article  PubMed  Google Scholar 

  8. Mori S, Kaneda T, Fujita Y, Kato M, Sakayanagi M, Minami M. Diffusion tensor tractography for the inferior alveolar nerve (V3): initial experiment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:270–4.

    Article  PubMed  Google Scholar 

  9. Fujiwara S, Sasaki M, Wada T, Kudo K, Hirooka R, Ishigaki D, et al. High-resolution diffusion tensor imaging for the detection of diffusion abnormalities in the trigeminal nerves of patients with trigeminal neuralgia caused by neurovascular compression. J Neuroimaging. 2011;21:e102–8.

    Article  PubMed  Google Scholar 

  10. Polak M, Polak G, Brocheriou C, Vigneul J. Solitary neurofibroma of the mandible: case report and review of the literature. J Oral Maxillofac Surg. 1989;7:65–8.

    Article  Google Scholar 

  11. Shapiro SD, Abramovitch K, Van Dis ML, Skoczylas LJ, Langlais RP, Jorgenson RJ, et al. Neurofibromatosis: oral and radiographic manifestations. Oral Surg Oral Med Oral Pathol. 1984;58:493–8.

    Article  PubMed  Google Scholar 

  12. Lee HH, Lian SL, Huang CJ, Huang MY. Tomotherapy for neurofibromatosis type 2: case report and review of the literature. Br J Radiol. 2010;83:e74–8.

    Article  PubMed  Google Scholar 

  13. Apostolidis C, Anterriotis D, Rapidis AD, Angelopoulos AP. Solitary intraosseous neurofibroma of the inferior alveolar nerve: report of a case. J Oral Maxillofac Surg. 2001;59:232–5.

    Article  PubMed  Google Scholar 

  14. Barnes L, Eveson JW, Reichart P, Sidransky D. Pathology and genetics of head and neck tumours. WHO classification of tumours. Lyon: IARC; 2005.

    Google Scholar 

  15. Chi AC, Carey J, Muller S. Intraosseous schwannoma of the mandible: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:54–65.

    Article  PubMed  Google Scholar 

  16. Metwaly H, Maruyama S, Cheng J, Hoshina H, Takagi R, Hayashi T, et al. Central schwannoma of the mandible: report of a case and review of the literature. Oral Med Pathol. 2010;15:29–33.

    Article  Google Scholar 

  17. Park YK, Kim YW, Yang MH, Kim EJ, Ryu DM. Neurilemmoma of the mandible. Skel Radiol. 1999;28:536–9.

    Article  Google Scholar 

  18. Yamazaki H, Kaneko A, Ota Y, Tsukinoki K. Schwannoma of the mental nerve: usefulness of preoperative imaging: a case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:122–6.

    Article  PubMed  Google Scholar 

  19. Robertson I, Cook MG, Wilson DF, Henderson DW. Malignant schwannoma of cranial nerves. Pathology. 1983;15:421–9.

    Article  PubMed  Google Scholar 

  20. Colmenero C, Rivers T, Patron M, Sierra I, Gamallo C. Maxillofacial malignant peripheral nerve sheath tumours. J Craniomaxillofac Surg. 1991;19:40–6.

    Article  PubMed  Google Scholar 

  21. Salla JT, Johann AC, Garcia BG, Aguiar MC, Mesquita RA. Retrospective analysis of oral peripheral nerve sheath tumors in Brazilians. Braz Oral Res. 2009;23:43–8.

    Article  PubMed  Google Scholar 

  22. Ohnishi M, Tanaka Y, Tutui T, Bann S. Extensive malignant schwannoma of the mandibular nerve. Case report. Int J Oral Maxillofac Surg. 1992;21:280–1.

    Article  PubMed  Google Scholar 

  23. Martin-Duverneuil N, Auriol M, Behin A, Bertrand JC, Chiras J. Facial malignant peripheral nerve sheath tumors. J Neuroradiol. 2006;33:237–49.

    Article  PubMed  Google Scholar 

  24. Longo F, De Maria G, Esposito P, Califano L. Primary non-Hodgkin’s lymphoma of the mandible. Report of a case. Int J Oral Maxillofac Surg. 2004;33:801–3.

    Article  PubMed  Google Scholar 

  25. Robbins KT, Fuller LM, Manning J, Goepfert H, Velasquez WS, Sullivan MP, et al. Primary lymphoma of the mandible. Head Neck Surg. 1986;8:192–9.

    Article  PubMed  Google Scholar 

  26. Bachaud JM, Coppin D, Douchez J. Primary malignant lymphoma of the mandible. A study of 3 cases and a review of the literature. Rev Stomatol Chir Maxillofac. 1992;93:372–6. (Article in French).

    Google Scholar 

  27. Barber HD, Stewart JC, Baxter WD. Non-Hodgkin’s lymphoma involving the inferior alveolar canal and mental foramen: report of a case. J Oral Maxillofac Surg. 1992;50:1334–6.

    Article  PubMed  Google Scholar 

  28. Bertolotto M, Cecchini G, Martinoli C, Perrone R, Garlaschi G. Primary lymphoma of the mandible with diffuse widening of the mandibular canal: report of a case. Eur Radiol. 1996;6:637–9.

    PubMed  Google Scholar 

  29. Buric N, Jovanovic G, Radovanovic Z, Buric M, Tijanic M. Radiographic enlargement of mandibular canal as first feature of non-Hodgkin’s lymphoma. Dentomaxillofac Radiol. 2010;39:383–8.

    Article  PubMed  Google Scholar 

  30. Gusenbauer AW, Katsikeris NF, Brown A. Primary lymphoma of the mandible: report of a case. J Oral Maxillofac Surg. 1990;48:409–15.

    Article  PubMed  Google Scholar 

  31. Schimming R, Lossnitzer A. Primary non-Hodgkin lymphoma of the mandible–a case report. Schweiz Monatsschr Zahnmed. 1999;109:837–43. (Article in French, German).

    Google Scholar 

  32. Maeda M, Kato H, Sakuma H, Maier SE, Takeda K. Usefulness of the apparent diffusion coefficient in line scan diffusion-weighted imaging for distinguishing between squamous cell carcinomas and malignant lymphomas of the head and neck. AJNR Am J Neuroradiol. 2005;26:1186–92.

    PubMed  Google Scholar 

  33. Lindqvist C, Teppo L, Sane J. Osteosarcoma of the mandible: analysis of nine cases. J Oral Maxillofac Surg. 1986;44:759–64.

    Article  PubMed  Google Scholar 

  34. Givol N, Buchner A, Taicher S, Kaffe I. Radiological features of osteogenic sarcoma of the jaws. A comparative study of different radiographic modalities. Dentomaxillofac Radiol. 1998;27:313–20.

    Article  PubMed  Google Scholar 

  35. Yagan R, Radivoyevitch M, Bellon EM. Involvement of the mandibular canal: early sign of osteogenic sarcoma of the mandible. Oral Surg Oral Med Oral Pathol. 1985;60:56–60.

    Article  PubMed  Google Scholar 

  36. Clark JL, Unni KK, Dahlin DC, Devine KD. Osteosarcoma of the jaw. Cancer. 1983;51:2311–6.

    Article  PubMed  Google Scholar 

  37. August M, Magennis P, Dewitt D. Osteogenic sarcoma of the jaws: factors influencing prognosis. Int J Oral Maxillofac Surg. 1997;26:198–204.

    Article  PubMed  Google Scholar 

  38. Garrington GE, Scofield HH, Cornyn J, Hooker SP. Osteosarcoma of the jaws: analysis of 56 cases. Cancer. 1967;20:377–91.

    Article  PubMed  Google Scholar 

  39. Bennett JH, Thomas G, Evans AW, Speight PM. Osteosarcoma of the jaws: a 30-year retrospective review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90:323–33.

    Article  PubMed  Google Scholar 

  40. Slootweg PJ, Muller H. Osteosarcoma of the jaw bones. Analysis of 18 cases. J Maxillofac Surg. 1985;13:158–66.

    Article  PubMed  Google Scholar 

  41. Kunzler A, Farmand M. Typical changes in the viscerocranium in acromegaly. J Craniomaxillofac Surg. 1991;19:332–40.

    Article  PubMed  Google Scholar 

  42. Burkes EJ. Vascular leiomyoma of the mandible: report of a case. J Oral Maxillofac Surg. 1995;53:65–6.

    Article  PubMed  Google Scholar 

  43. Schenberg ME, Zajac JD, Lim-Tio S, Collier NA, Brooks AM, Reade PC. Multiple endocrine neoplasia syndrome–type 2b. Case report and review. Int J Oral Maxillofac Surg. 1992;21:110–4.

    Article  PubMed  Google Scholar 

  44. Hell B, Freitag V. Lower lip carcinoma. Infiltration of the mandible along the mental nerve. J Craniomaxillofac Surg. 1988;16:76–9.

    Article  PubMed  Google Scholar 

  45. Ikeda K, Ho KC, Nowicki BH, Haughton VM. Multiplanar MR and anatomic study of the mandibular canal. AJNR Am J Neuroradiol. 1996;17:579–84.

    PubMed  Google Scholar 

  46. Halazonitis JA, Kountouris J, Halazonitis NA. Arteriovenous aneurysm of the mandible. Oral Surg Oral Med Oral Pathol. 1982;53:454–7.

    Article  PubMed  Google Scholar 

  47. Horswell BB, Holmes AD. Arteriovenous malformation in the mandible of a young child. Aust N Z J Surg. 1988;58:73–6.

    Article  PubMed  Google Scholar 

  48. Mohammadi H, Said-al-Naief NA, Heffez LB. Arteriovenous malformation of the mandible: report of a case with a note on the differential diagnosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997;84:286–9.

    Article  PubMed  Google Scholar 

  49. Kohout MP, Hansen M, Pribaz JJ, Mulliken JB. Arteriovenous malformations of the head and neck: natural history and management. Plast Reconstr Surg. 1998;102:643–54.

    PubMed  Google Scholar 

  50. Siu WW, Weill A, Gariepy JL, Moret J, Marotta T. Arteriovenous malformation of the mandible: embolization and direct injection therapy. J Vasc Interv Radiol. 2001;12:1095–8.

    Article  PubMed  Google Scholar 

  51. Sakkas N, Schramm A, Metzger MC, Berlis A, Schmelzeisen R, Otten JE, et al. Arteriovenous malformation of the mandible: a life-threatening situation. Ann Hematol. 2007;86:409–13.

    Article  PubMed  Google Scholar 

  52. Vilos GA, Rapidis AD, Lagogiannis GD, Apostolidis C. Leiomyosarcomas of the oral tissues: clinicopathologic analysis of 50 cases. J Oral Maxillofac Surg. 2005;63:1461–77.

    Article  PubMed  Google Scholar 

  53. Vartiainen VM, Siponen M, Salo T, Rosberg J, Apaja-Sarkkinen M. Widening of the inferior alveolar canal: a case report with atypical lymphocytic infiltration of the nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:e35–9.

    PubMed  Google Scholar 

  54. Arribas-Garcia I, Alcala-Galiano A, Gutierrez R, Montalvo-Moreno JJ. Traumatic neuroma of the inferior alveolar nerve: a case report. Med Oral Patol Oral Cir Bucal. 2008;13:E186–8.

    PubMed  Google Scholar 

  55. Ethunandan M, Weller RO, McVicar IH, Fisher SE. Localized hypertrophic neuropathy involving the inferior alveolar nerve. J Oral Maxillofac Surg. 1999;57:84–9.

    Article  PubMed  Google Scholar 

  56. Becktor KB, Becktor JP, Karnes PS, Keller EE. Craniofacial and dental manifestations of Proteus syndrome: a case report. Cleft Palate Craniofac J. 2002;39:233–45.

    Article  PubMed  Google Scholar 

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Terzic, A., Becker, M., Imholz, B. et al. Unilateral widening of the inferior alveolar nerve canal: a rare anatomic variant mimicking disease. Oral Radiol 29, 160–165 (2013). https://doi.org/10.1007/s11282-012-0118-9

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  • DOI: https://doi.org/10.1007/s11282-012-0118-9

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