Bilateral anomalous high position of the mandibular foramen: a case report

The inferior alveolar nerve block is one of the most common techniques for delivering dental anesthesia. Its success depends on placing the needle tip in close proximity to the mandibular foramen (MF). In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Anatomical variability may be one source of local anesthetic failure and includes bone and nerve variations. A case is presented of a bilateral anomalous high position of the MF, identified from the panoramic radiograph. An adjusted anesthetic technique (the Vazirani-Akinosi technique) was used to achieve local anesthesia before extraction of a lower second molar following an unsuccessful conventional indirect technique with a higher entry point. A description of the embryological basis for the anomalous high positioned MF and its impact from a practical and clinical perspective, with particular reference to local anatomy, is included.