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MRI of the inferior alveolar nerve and lingual nerve—anatomical variation and morphometric benchmark values of nerve diameters in healthy subjects

  • Egon BurianEmail author
  • Florian A. Probst
  • Dominik Weidlich
  • Carl-Peter Cornelius
  • Lisa Maier
  • Teresa Robl
  • Claus Zimmer
  • Dimitrios C. Karampinos
  • Lucas M. Ritschl
  • Monika Probst
Original Article

Abstract

Objective

Since MRI using dedicated imaging sequences has recently shown promising results in direct visualization of the inferior alveolar nerve (IAN) and the lingual nerve (LN) with high spatial resolution, the aim of this study was to generate suitable standard specifications to reliably depict the IAN and LN in MRI and to delineate the anatomy and its variants of these nerves in healthy subjects.

Methods

Thirty healthy volunteers were examined on a 3-T scanner (Elition, Philips Healthcare, Best, the Netherlands). The sequence protocol consisted of 3D STIR, 3D DESS, and 3D T1 FFE “black bone” sequences.

Results

The study reconfirmed a good feasibility of direct visualization of proximal and peripheral portions of the IAN and of the proximal course of the LN. The STIR sequence showed the highest apparent signal to noise ratio (aSNR) and best apparent nerve-muscle contrast to noise ratio (aNMCNR) for IAN and for the LN. The applied MRI sequences allowed to differentiate the tissue composition of the neurovascular bundle inside the mandibular canal.

Conclusion

Dedicated MRI sequence protocols proved effectively to detect the IAN and LN and their course in healthy volunteers. The tissue composition of the mandibular neurovascular bundle was conclusively distinguishable as was the varying topography inside multiple bony channels.

Clinical relevance

The presented data on the precise and valid visualization of the IAN and LN have clinical implications in respect to local anesthesia prior to dental treatments in the mandible but also regarding surgical procedures and implant insertion in the molar region.

Keywords

MRI Inferior alveolar nerve Lingual nerve Imaging Preoperative diagnostics 

Abbreviations

aNMCNR

Apparent nerve-muscle contrast to noise ratio

aSNR

Apparent signal to noise ratio

CBCT

Cone beam computed tomography

CI

Confidence interval

CT

Computed tomography

CNR

Contrast to noise ratio

DESS

Double-echo steady state

IAN

Inferior alveolar nerve

LN

Lingual nerve

MRI

Magnetic resonance imaging

ROI

Region of interest

SD

Standard deviation

SI

Signal intensity

STIR

Short tau inversion recovery

Notes

Author contributions

Egon Burian: data segmentation, drafting of manuscript, concept of study design, data acquisition, data post-processing.

Florian A. Probst: critical revision of manuscript.

Dominik Weidlich: critical revision of manuscript.

Carl-Peter Cornelius: critical revision of manuscript.

Lisa Meier: data acquisition, critical revision of manuscript.

Teresa Robl: data acquisition, critical revision of manuscript.

Claus Zimmer: critical revision of manuscript.

Dimitrios C. Karampinos: critical revision of manuscript.

Lucas Ritschl: critical revision of manuscript.

Monika M. Probst: concept of study design, data acquisition, data post-processing, statistical analysis, critical revision of manuscript.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

The institutional ethics committee approved the study design.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Egon Burian
    • 1
    Email author
  • Florian A. Probst
    • 2
  • Dominik Weidlich
    • 3
  • Carl-Peter Cornelius
    • 2
  • Lisa Maier
    • 1
  • Teresa Robl
    • 1
  • Claus Zimmer
    • 1
  • Dimitrios C. Karampinos
    • 3
  • Lucas M. Ritschl
    • 4
  • Monika Probst
    • 1
  1. 1.Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.Department of Oral and Maxillofacial Surgery and Facial Plastic SurgeryUniversity Hospital, LMU MunichMunichGermany
  3. 3.Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  4. 4.Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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