Abstract
This study aims to investigate positions of the antilingula (AL), the midwaist of the mandibular ramus (MW) and the midpoint between the coronoid process and the gonion (MCG) in relation to the lingula of dried mandibles. Bilateral rami of 92 Thai dried mandibles were studied. The AL, the MW, the MCG and the corresponding position of the tip of lingula (L) were marked on the external aspect of the mandibular ramus. The distances from the AL, the MW and the MCG to the L were measured in the anterior–posterior and the superior–inferior planes using computerized image analysis. The results showed the AL was discernible in 80.4% of lateral mandibular rami studied. The most of the AL was found anterior–superior to the L with a maximum distance of 5.9 mm anteriorly and 8.2 mm superiorly. The MW was frequently located anterior–inferior to the L with a maximum distance of 9.3 mm anteriorly and 9.9 mm inferiorly. The majority of the MCG was found anterior–superior to the L with a maximum distance of 9.6 mm anteriorly and 8.9 mm superiorly. A 5 mm radius from the L included 84.5% of the AL, 81.5% of the MW and 79.4% of the MCG. Medians (interquartiles) of distances from the AL, the MW and the MCG to the L were 3.4 (2.3–5.0) mm, 3.8 (2.5–5.3) mm and 4.1 (2.8–5.3) mm, respectively. In conclusion, the AL was identified in 80.4% of lateral mandibular rami studied. The AL and the MCG were commonly found anterior–superior to the lingula, whereas the MW was mostly observed anterior–inferior to the lingula. Therefore, a cut made more than a 5 mm posterior or superior to these landmarks would be in 79% of cases, within a statistically safe area avoiding encroaching upon the inferior alveolar neurovascular bundle passing immediately lateral to the lingula. Although the MW and the MCG might be alternative surgical guides when the AL is absent, their use alone as surgical landmarks is not recommended.
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References
Al-Bishri A, Barghash Z, Rosenquist J et al (2005) Neurosensory disturbance after sagittal split and intraoral vertical ramus osteotomy: as reported in questionnaires and patients’ records. Int J Oral Maxillofac Surg 34:247–251
Aziz SR, Dorfman BJ, Ziccardi VB et al (2007) Accuracy of using the antilingula as a sole determinant of vertical ramus osteotomy position. J Oral Maxillofac Surg 65:859–862
Behrman SJ (1972) Complications of sagittal osteotomy of the mandibular ramus. J Oral Surg 30:554–561
Bell W, Proffit W, White R (1980) Surgical correction of dentofacial deformities. Saunders, Philadelphia, pp 855–901
Bell WH, Yamaguchi Y (1991) Condyle position and mobility before and after intraoral vertical ramus osteotomies and neuromuscular rehabilitation. Int J Adult Orthodon Orthognath Surg 6:97–104
Byrne RP, Hinds EC (1974) The ramus “C” osteotomy with body sagittal split. J Oral Surg 32:259–263
Caldwell JB, Hayward JR, Lister RL (1968) Correction of mandibular retrognathia by vertical L osteotomy: a new technic. J Oral Surg 26:259–264
Caldwell JB, Letterman GS (1954) Vertical osteotomy in the mandibular rami for correction of prognathism. J Oral Surg 12:185–202
Fujimura K, Segami N, Sato J et al (2005) Comparison of the clinical outcomes of patients having sounds in the temporomandibular joint with skeletal mandibular deformities treated by vertico-sagittal ramus osteotomy or vertical ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:24–29
Ghali GE, Sikes JW Jr (2000) Intraoral vertical ramus osteotomy as the preferred treatment for mandibular prognathism. J Oral Maxillofac Surg 58:313–315
Hall HD, Chase DC, Payor LG (1975) Evaluation and refinement of the intraoral vertical subcondylar osteotomy. J Oral Surg 33:333–341
Hall HD, McKenna SJ (1987) Further refinement and evaluation of intraoral vertical ramus osteotomy. J Oral Maxillofac Surg 45:684–688
Hall HD, Nickerson JW Jr, McKenna SJ (1993) Modified condylotomy for treatment of the painful temporomandibular joint with a reducing disc. J Oral Maxillofac Surg 51:133–142
Hayes PA (1973) Correction of retrognathia by modified “C” osteotomy of the ramus and sagittal osteotomy of the mandibular body. J Oral Surg 31:682–686
Hogan G, Ellis E III (2006) The “antilingula”—fact or fiction? J Oral Maxillofac Surg 64:1248–1254
Langston JR, Tebo HG (1977) The incidence and relationship of the lateral ramus prominence to the mandibular foramen. Oral Surg Oral Med Oral Pathol 44:190–196
Martone CH, Ben-Josef AM, Wolf SM et al (1993) Dimorphic study of surgical anatomic landmarks of the lateral ramus of the mandible. Oral Surg Oral Med Oral Pathol 75:436–438
McKenna SJ (2006) Modified mandibular condylotomy. Oral Maxillofac Surg Clin North Am 18:369–381
Pogrel MA, Schmidt BL, Ammar A (1995) The presence of the antilingula and its relationship to the true lingula. Br J Oral Maxillofac Surg 33:235–238
Reitzik M, Griffiths RR, Mirels H (1976) Surgical anatomy of the ascending ramus of the mandible. Br J Oral Surg 14:150–155
Tamas F (1979) The groove of the mandibular neck as a risk factor in vertical osteotomy of the ramus of the mandible. Int J Oral Surg 8:1–7
Tominaga K, Yoshioka I, Nakahara T et al (2002) A simple technique to avoid the mandibular nerve in intraoral vertical ramus osteotomy. J Oral Maxillofac Surg 60:1089–1091
Troulis MJ, Kaban LB (2004) Endoscopic vertical ramus osteotomy: early clinical results. J Oral Maxillofac Surg 62:824–828
Yates C, Olson D, Guralnick W (1976) The antilingula as an anatomic landmark in oral surgery. Oral Surg Oral Med Oral Pathol 41:705–708
Zaytoun HS Jr, Phillips C, Terry BC (1986) Long-term neurosensory deficits following transoral vertical ramus and sagittal split osteotomies for mandibular prognathism. J Oral Maxillofac Surg 44:193–196
Acknowledgments
This study was supported with a Grant from the Dental Research Fund, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand. We gratefully acknowledge the Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University and the Department of Anatomy, Faculty of Dentistry, Chulalongkorn University for sample provision. Special thanks are expressed to Miss Paipun Phitayanon, an instructor, for her statistical advice and Dr. Kevin Tompkins, Chulalongkorn University for critically reviewing this manuscript.
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Apinhasmit, W., Chompoopong, S., Jansisyanont, P. et al. The study of position of antilingula, midwaist of mandibular ramus and midpoint between coronoid process and gonion in relation to lingula of 92 Thai dried mandibles as potential surgical landmarks for vertical ramus osteotomy. Surg Radiol Anat 33, 337–343 (2011). https://doi.org/10.1007/s00276-010-0700-y
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DOI: https://doi.org/10.1007/s00276-010-0700-y