Appearance of the mandibular incisive canal on panoramic radiographs

Panoramic radiographs are routinely used in the dental office for various diagnostic purposes. This study aimed to evaluate the visibility of neurovascular structures in the mandibular interforaminal region on such radiographs. Panoramic radiographs were obtained with a Cranex Tome (Soredex) from 545 consecutive patients using a standard exposure and positioning protocol. For visibility scoring of neurovascular structures, a four-point rating scale was used. The mandibular canal and the mental foramen could be observed in the majority of the cases with good visibility. The lingual foramen was visualized in 71% of the cases, with good visibility in 12%. An incisive canal was identified in 15% of the images, with good visibility in only 1%. An anatomical variation to be considered is the anterior looping of the mental nerve (in 11% of images). Panoramic radiographs can be used for visualization of the mental foramen and a potential anterior looping but not for locating the mandibular incisive canal. To verify its existence for preoperative planning purposes, cross-sectional imaging modalities (HR-CT or spiral tomography) should be preferred

Presence and course of the incisive canal in the human mandibular interforaminal region: two-dimensional imaging versus anatomical observations

The objective of the present study was to evaluate the presence and course of the incisive canal in the mental interforaminal region of the human mandible and to describe the occurrence of anatomical variations. Mandibles of 50 adult human cadavers were retrieved from the Department of Anatomy of the Faculty of Medicine, Katholieke Universiteit Leuven (Leuven, Belgium). Forty mandibles were edentulous, while 10 mandibles were partially dentate. Intra-oral, panoramic and tomographic imaging of the interforaminal region of the human mandible were performed. Afterwards, mandibles were sawn into vertical sections according to the respective tomographic cross-sections. The latter allowed exploration for the presence and course of an anterior prolongation of the mandibular canal. Measurements of the location of the incisive canal towards the base of the mandible were made using a digital-sliding caliper. Results indicated a well-defined incisive canal [mean (SD) inner diameter 1.8 (0.5 mm)], macroscopically observed in 96% of mandibles. The incisive canal was located on average 9.7 mm (SD 1.8 mm) from the lower cortical border and continued towards the incisor region in a slightly downward direction, with a mean (SD) distance to the lower cortical border of 7.2 (2.1) mm. It was concluded that there is an anterior intraosseous extension of the mandibular canal, denoted as the incisive canal. The latter might be considered as a true anterior extension of the neurovascular bundle. Histological and neurophysiological studies are needed to verify this hypothesis and evaluate its potential clinical implications

The nasopalatine canal revisited using 2D and 3D CT imaging

OBJECTIVES: To assess the location, morphology and dimensions of the nasopalatine canal on two-dimensional and three-dimensional (2D and 3D) CT images. METHODS: Material included 34 spiral CT scans for pre-operative planning of implant placement in the maxilla. Scanning was performed using a standard exposure and patient positioning protocol. 2D and 3D spiral CT images were carefully examined for the location, morphology and dimensions of the nasopalatine canal by two independent observers. A comparison was made between 2D observations and a 2D/3D combined observation strategy (paired t-tests). RESULTS: The nasopalatine canal typically appeared as a canal with a mean (standard deviation (SD)) length of 8.1 (3.4) mm. Its palatal opening is the incisive foramen with a mean (SD) inner Ø of 4.6 (1.8) mm. At the level of the nasal floor often 2 (Y-canal morphology), but sometimes 3 or 4 openings could be observed. In particular cases, the canal showed up as a cylinder with only one nasal opening. The average (SD) maximum width of the nasopalatine canal structure at the level of the nasal floor was 4.9 (1.2) mm. The buccopalatal width of the jaw, anterior to the canal was 7.4 (2.6) mm. Interpretation of canal morphology was significantly different when comparing 2D image observation with a 2D/3D combined observation strategy. However, dimensional measurements of the canal were not significantly different for a 2D and a combined 2D/3D approach. CONCLUSIONS: The nasopalatine canal may show important anatomical variations, both with regard to morphology and dimensions. To avoid any potential complications during surgical procedures such as implant placement, a careful pre-operative observation is required. Cross-sectional imaging may be advocated to determine canal morphology and dimensions and to assess anterior bone width for potential implant placement buccally to the canal.Mraiwa N., Jacobs R., Van Cleynenbreugel J., Sanderink G., Schutyser F., Suetens P., van Steenberghe D., Quirynen M., ''The nasopalatine canal revisited using 2D and 3D CT imaging'', Dentomaxillofacial radiology, vol. 33, pp. 396-402, 2004.status: publishe