Arteriographic assessment of patency of the inferior alveolar artery and its relevance to alveolar atrophy

Patency of the inferior alveolar artery was investigated on 84 patients who had undergone selective external carotid angiography with digital subtraction. Patency of the artery was lost earlier in males than females, but the presence or absence of teeth did not appear to affect the outcome. The artery was visualized less well on patients with medical conditions that may predispose to early or excessive atherosclerotic disease.     

A radiological study of degenerative vascular changes in the external carotid region and carotid bifurcation

In a series of 79 autopsies performed on subjects aged from 18 to 95 years occlusions in the external carotid, maxillary and inferior alveolar arteries were rare: only two cases were found in the maxillary and one in the inferior alveolar arteries. Tortuosity of the arteries increased with age, being most extensive in the external carotid and least in the inferior alveolar artery. Variations in the diameter of the maxillary artery occurred in 11 persons (14%), the incidence increasing with age. The youngest person showing such changes was aged 55 years. The average diameter of the arterial lumen of the inferior alveolar artery decreased with advancing age. This narrowing of the lumen also correlated with the loss of teeth. Calcified atherosclerotic plaques in the carotid bifurcation were present in 59% of the cases studied. In persons aged over 60 years a correlation was found between the carotid calcifications and coronary artery disease.     

Histologic evaluation of inferior alveolar lymphatics: an anatomic study

The purpose of this study was to investigate the presence of a lymphatic system within the inferior alveolar canal, using specific immunohistochemical staining. Lymphatic capillaries are characterized by a thin wall with an irregular profile. They are superficial to organs and collect the lymph. Currently, the lymphatic system of the mandible and the floor of the mouth are attributed to the periosteum. The inferior alveolar canal within the mandible houses the inferior alveolar nerve, artery, and vein. Owing to the surgical vulnerability of the canal, several recent studies have focused on defining the exact contents and arrangements within the canal as well as precise measurements of the diameter of its components. No study has been performed on the existence of a lymphatic system within the inferior alveolar canal, the presence of which has significant importance for surgical management of malignant lesions. Presence of lymph channels would make the inferior alveolar nerve a potential route for spreading malignant cells. In this study, podoplanin-positive thin-walled vessels, considered to be lymphatic vessels, were traced within the inferior alveolar canal.     

Perforation of the inferior alveolar nerve by the maxillary artery: An anatomical study

The infratemporal fossa is a clinically important anatomical area for the delivery of local anaesthetic agents in dentistry and maxillofacial surgery. We studied the infratemporal fossas in white cadavers, and in particular the topographical relations of the inferior alveolar nerve and the maxillary artery. In 3 of the 50 fossas dissected the maxillary artery passed through the inferior alveolar nerve, splitting it into superficial and deep divisions. Entrapment of the maxillary artery may cause numbness or headache and may interfere with injection of local anaesthetics into the infratemporal fossa.     

Variations in the anatomy of the inferior alveolar nerve

Variations in the anatomy of the inferior alveolar nerve were seen in 2 of the 20 dissections of the infratemporal fossa in 10 cadavers. A connecting nerve branch that originated from the auriculotemporal nerve joined the inferior alveolar nerve on both sides. The second part of the maxillary artery passed between the mandibular nerve, the root of the inferior alveolar nerve, and the connecting nerve branch which formed a loop. The maxillary artery seemed to be entrapped. Neurovascular entrapment can cause pain and numbness. Anatomical variations in this region should be kept in mind, particularly in cases of failed treatment of trigeminal neuralgia.     

Detection of radiation-accelerated atherosclerosis of the carotid artery by panoramic radiography. A new opportunity for dentists

BACKGROUND: The authors review the pathophysiology, epidemiology, course of disease, dental findings and dental treatment of patients who developed atherosclerosis of the carotid artery after having received therapeutic radiation to the neck for squamous-cell carcinoma of the oral cavity, pharynx or larynx; salivary gland tumors; and lymphomas involving the cervical lymph nodes. TYPE OF STUDIES REVIEWED: The authors conducted a MEDLINE search for 1997 through 2002 using the key terms "radiation therapy," "carotid artery" "atherosclerosis," "cancer" and "dentistry." The articles selected for further review included those published in English in peer-reviewed journals, with preference given to articles reporting randomized, controlled trials. RESULTS: Recent advances in the delivery of radiation therapy to malignancies of the head and neck have resulted in the prolonged survival of increasing numbers of patients. However, the therapy has been implicated as causing atherosclerotic lesions in the cervical component of the carotid artery, which predisposes patients to an increased risk of developing stroke. Panoramic radiography can identify some of these lesions before they can cause a stroke. Radiation-induced atherosclerosis is common, with approximately 40 percent of patients developing hemodynamically significant carotid artery plaques within 10 years of having received irradiation. CLINICAL IMPLICATIONS: Dentists treating patients who have received therapeutic radiation to the neck should examine the patients' panoramic radiographs for evidence of atheromalike calcifications, which appear 1.5 to 2.5 centimeters posterior and inferior to the angle of the mandible. Patients with evidence of such lesions should be referred to their physician for an ultrasound examination of their carotid arteries.     

Optimum conditions for detecting the inferior alveolar artery using phase-contrast magnetic resonance angiography

Objectives  

The inferior alveolar artery (IAA), accompanied by the inferior alveolar nerve, runs through the mandibular canal. The mandibular canal can be observed by conventional radiography and computed tomography, although it is sometimes difficult to identify on these images. This study examined visualization of the IAA with phase-contrast magnetic resonance angiography (PC-MRA).     

Importance of anatomy in dental implant surgery

BackgroundThe knowledge of nerves and vessels in the maxillofacial region, particularly the anatomical structures in the maxilla, mandible, tongue muscles, and salivary glands, is essential for dental surgeons. In addition, the structures in the mandibular canal, palate, and maxillary sinus should be understood well.HighlightThe arteries and nerves in the maxillofacial region were observed in this study. Some variations in the origin of the inferior alveolar artery were found. Notably, the variations in the origin of the inferior alveolar artery from that of the external carotid artery and a double origin of the inferior alveolar artery were observed. Thus, the maxillary artery may originate from the external carotid and stapedial arteries. The following points are important. (1)The greater palatine artery is always located deeper than the greater palatine nerve. (2)The posterior superior alveolar artery often runs through the compact bone of the maxilla. Using CT scans, the canal of the artery can be observed. (3)Variations in origins of the inferior alveolar artery have been observed. The origin of the inferior alveolar nerve may differ depending on the course of the maxillary artery.ConclusionsDental practitioners should, therefore, have a comprehensive knowledge of the anatomy of the maxillofacial region and its variations. Without this knowledge, they should not operate on patients.     

Diagonal ear lobe crease and atherosclerosis: a review of the medical literature and dental implications

In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodomal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient's medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk.     

锥形束CT对上牙槽后动脉骨孔的测量分析研究

目的 通过锥形束CT（CBCT）影像评估上牙槽后动脉骨孔位置、大小及与剩余牙槽骨的关系。方法 选择2011年4月-2012年9月前来南昌大学附属口腔医院种植科要求行上颌窦底提升手术和(或)上颌磨牙区种植手术,并且拍摄CBCT的患者116名,测量记录其上牙槽后动脉骨孔下缘至剩余牙槽嵴顶间距、上牙槽后动脉骨孔直径、剩余牙槽嵴高度,对各测量值进行统计分析。结果 入选116名患者中上牙槽后动脉骨孔的发现率为75.14%（133/177）;骨孔的平均直径为（0.96±0.29） mm;剩余牙槽嵴高度平均值为（7.14±3.64） mm;上牙槽后动脉骨孔下缘距剩余牙槽嵴顶间距均值为（17.92±5.68） mm。经采用独立样本t检验发现性别对骨孔直径影响差异有统计学意义（F= 0.187,P<0.05）;右侧和左侧骨孔间差异无统计学意义（F=0.295,P>0.05）。上牙槽后动脉骨孔下缘距牙槽嵴顶间距与剩余牙槽嵴高度显著正相关。结论 CBCT在发现上牙槽后动脉骨孔具有较明显的优势。     

The clinical anatomy of the maxillary artery in the pterygopalatine fossa.

PURPOSE: The purposes of this study were to delineate the maxillary artery and its branching arteries and to develop a classification of the various branching patterns by means of serial cadaver dissections of the pterygopalatine fossa region. MATERIALS AND METHODS: Fifteen Korean adult cadavers were used; 2 sides of each cadaver were examined, for a total of 30 sides. Before dissection of the pterygopalatine region, computed tomography scan was taken of 20 cadaver heads. Sectioned specimens of 9 sides of the cadaver heads in 3.0-mm thickness were made for this study. Then we dissected 21 sides of fresh cadavers under the microscope. In this investigation, we observed branching patterns of the third portion of the maxillary artery, a relationship of the terminal branches of the maxillary artery to the pterygomaxillary junction, and the course of descending palatine artery. Then we classified the branching patterns of the maxillary artery in the pterygopalatine fossa. RESULTS: From the pterygomaxillary junction to the pterygopalatine fossa region, the maxillary artery was usually branched into 5 arteries in the following order: posterior superior alveolar artery, infraorbital artery, artery of the pterygoid canal, descending palatine artery, and sphenopalatine artery. Of 21 cadavers, 18 showed this order (85.7%). There were 2 types of branching patterns of the posterior superior alveolar artery and the infraorbital artery. The average distance from the most inferior point of the pterygomaxillary junction to the posterosuperior alveolar artery, infraorbital artery, and descending palatine artery was 15.2, 32.2, and 24.8 mm, respectively. In most cases (95.2%), the greater and lesser palatine arteries were divided from the short descending palatine artery. According to the contours of the third portion of the maxillary artery, we classified them into 5 types: the "Y" type (19%), "intermediate" type (33.3%), "T" type (23.8%), and "M" type (14.3%). CONCLUSION: The results of this investigation show the common patterns of the maxillary artery.     

An investigation of possible age-related changes in the inferior alveolar artery in man

An histological examination of inferior alveolar arteries removed at post-mortem, from 16 human subjects failed to show significant age-related changes in luminal patency which would lead to narrowing and eventual obliteration of this structure. It is suggested that the artery continues, throughout life, to provide the major internal blood supply to the mandible.     

Histomorphometric analysis of age changes in the human inferior alveolar artery

Angiography is often used to investigate age-related changes in the inferior alveolar artery, the major nutrient artery of the mandible. Although histological examinations have been made from several viewpoints, e.g. age change, pathogenesis of osteoradionecrosis, and relation to tooth extraction, these studies have used a limited number of samples and simple histometric methods. The purpose here was to describe histopathological and histomorphometric age-related changes, and to investigate the relation between dentate status and the histomorphometry of the artery. Inferior alveolar arteries from 162 autopsy cases (age range 3-86 years) were examined histometrically with a mathematically standardized method. Histologically, there was diffuse fibrous intimal thickening, but no atheroma formation. Histometric analyses revealed a very gradual increase in both the radius of the artery and the thickness of the media with age, but the luminal radius did not correlate with age. Intimal thickness increased exponentially with age with very different features from those of the increase in the media. The relative radius of the lumen decreased with age after the sixth decade; this is thought to be an index for senile changes in the artery. Among the variables of arterial architecture examined, no particular difference was found between the dentate and non-dentate cases in the molar region.     

Aneurysmal atherosclerosis of the inferior labial artery with segmental arteriectomy.

A case of aneurysmal atherosclerosis of the inferior labial artery has been presented in which a segmental arteriectomy was performed to eliminate the possibility of involuntary trauma to the area, which could produce considerable hemorrhage. Psychologicall, the patient felt better by knowing that the mass was completely removed. Atherosclerosis should be considered when masses are found in the lips in elderly patients. It is thought that this lesion is common but has not been reported in the past.     

Proximity of Impacted Mandibular Third Molars to the Inferior Alveolar Canal and Its Radiographic Predictors: A Panoramic Radiographic Study

Purpose

To assess the radiographic proximity of impacted mandibular third molars to the inferior alveolar canal on panoramic radiographs. The radiographic distance between the impacted mandibular third molars and inferior alveolar canal and the reliable radiographic risk predictor signs that indicate close proximity between these two structures were evaluated.

Methods

The study comprised of 64 subjects with 68 symptomatic impacted mandibular third molars for whom panoramic radiographs were made. The radiographs were interpreted for type of impaction, radiographic distance between impacted mandibular third molars to inferior alveolar canal and presence of one or more of the seven radiographic risk predictor signs. Further, these teeth were surgically removed and the proximity was assessed based on the exposure of inferior alveolar canal/nerve which was considered as Gold standard.

Results

The overall mean distance from the impacted mandibular third molars to inferior alveolar canal was −0.50 mm. Most of the samples (61.8 %) extended beyond the superior border of the inferior alveolar canal with a mean distance of −1.40 mm. Mesioangular impactions were found to be in the close proximity (−1.14 mm) to inferior alveolar canal than any other type. Interruption of the white line was the only statistically significant radiographic risk predictor sign p = 0.006 (< 0.05) that indicated close proximity of impacted mandibular third molars to inferior alveolar canal.

Conclusion

It can be concluded that panoramic radiographs are reliable in assessing the proximity of impacted mandibular third molars to inferior alveolar canal. Mesioangular impactions are more closely placed to inferior alveolar canal and interruption of the white line is the most reliable risk predictor sign on the panoramic radiographs.     

The arterial blood supply of the human mandible]

The arteries of 22 mandibles injected with Kallocryl M were examined. The first group consisted of mandibles with the full complement of teeth. At the inner side, there were numerous anastomoses between the submental artery, the sublingual artery, the ascending palatine artery and the mylohyoid ramus. Furthermore, the dental rami branched into the periost. At the outside, the mental artery as well as the submental and inferior labial arteries contributed to the arterial supply. In the second group of mandibles (with intact incisors), these war a marked reduction of the anastomoses of the inferior alveolar artery in the middle region. The third group of mandibles (which were edentulous) showed anastomoses of the submental and sublingual arteries in the region of the incisors. The outside was supplied by the submental and inferior labial arteries. The mental artery exislar artery was demonstrated in 4 cases. The reduction of anastomoses concerned the inferior alveolar artery.     

Age changes in the human inferior alveolar artery--a histological study

The inferior alveolar artery was examined histologically in non-irradiated surgically resected mandibles. A total of 39 edentulous and 11 partially dentate specimens was studied. Narrowing of the lumen was most commonly due to arteriosclerosis which confirms previous reports. Stenosis was not found to be either commoner or more severe than that recorded in other arteries in the body. It is suggested that apparent narrowing of the inferior alveolar artery seen on angiography may represent a form of involutional atrophy of the artery associated with dental extraction and progressive resorption of the residual occlusal alveolar ridge.     

Pseudoaneurysm in the inferior alveolar artery following a bad split in bilateral sagittal split osteotomy

Pseudoaneurysms in the external carotid artery system are rare, mostly reported in the superficial temporal and facial arteries. The bilateral sagittal split osteotomy has a low incidence of complications requiring emergency interventions. We report the case of a patient with acute bleeding from a pseudoaneurysm of the inferior alveolar artery diagnosed by angiography and treated successfully by super-selective embolization.     

Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study

Objectives: Knowledge and evaluation of the maxillary sinus anatomy before sinus augmentation are essential for avoiding surgical complications. Posterior superior alveolar artery (PSAA) is the branch of maxillary artery that supplies lateral sinus wall and overlying membrane. The aims of this study were to examine the prevalence, diameter, and location of the PSAA and its relationship to the alveolar ridge and to study the prevalence of the sinus pathology and septum using computerized tomography (CT) scans. Materials and methods: One hundred and twenty‐one CT scans (242 sinuses) from patients undergoing sinus augmentation procedure and/or implant therapy were included. Lower border of the artery to the alveolar crest, bone height below the sinus floor to the ridge crest, distance of the artery to the medial sinus wall, diameter of the artery, and position of the artery were measured; presence of septa and pathology were recorded from CT sections. Results: Prevalence of sinus septa and sinus pathology was 16.1% and 24.8%, respectively. Artery was seen in 64.5% of all sinuses and was mostly intraosseous (68.2%). Mean diameter of PSAA was found 1.3 ± 0.5 mm. No significant correlation between the diameter of the artery and age was observed. Conclusions: The results from this study suggested that CT scan is a valuable tool in evaluating presence of sinus pathology, septa, and arteries before maxillary sinus surgery. Although variations exist in every patient, the findings from this study suggest limiting the superior border of the lateral window up to 18 mm from the ridge to avoid any potential vascular damage. To cite this article:
Güncü GN, Yildirim YD, Wang H‐L, Tözüm TF. Location of posterior superior alveolar artery and evaluation of maxillary sinus anatomy with computerized tomography: a clinical study.
Clin. Oral Impl. Res. 22 , 2011; 1164–1167.
doi: 10.1111/j.1600‐0501.2010.02071.x     

Calcification of the branches of the external carotid artery detected by panoramic radiography: a case report

Atherosclerosis, a progressive inflammatory disease, may lead to stroke, coronary artery disease, or peripheral artery disease. The prevalence of atherosclerosis associated with morbidity and mortality is very high in industrialized countries. This report describes the case of a 49-year-old male patient whose panoramic radiograph taken as part of a dental examination showed calcification in the branches of the external carotid artery. The right facial artery and left maxillary, facial, and lingual arteries were also calcified. The patient had a history of thrombosis in the right axillary and brachial veins with extension to half of the brachiocephalic trunk. In addition, selective lesions were found in the aorta and mitral valve. The patient's medical history also included hypertriglyceridemia, essential arterial hypertonia, terminal renal insufficiency, renal anemia, neurogen disturbance micturition, secondary hyperparathyroidism, hyperuricemia, lymphatic edema, polyneuropathy, tachyarrhythmia absoluta, and erysipelas. The case presented reports on the possibility of detecting signs of atherosclerosis in arteries of the maxillofacial region by use of panoramic radiography.