Galore International Journal of Health Sciences and Research Vol.3; Issue: 3; July-Sept. 2018 Website: www.gijhsr.com Original Research Article P-ISSN: 2456-9321 An Anatomico-Radiological Study of Inter-Relationship between the Mandibular Foramen and Accessory Mandibular Foramina in Population of Rajasthan State Sakshi Mathur1, Puneet Joshi2 1,2Ph.D. Scholar, Department of Anatomy, Sawai Man Singh Medical College & Hospital, Jaipur Corresponding Author: Sakshi Mathur ________________________________________________________________________________________________________________ ABSTRACT ramus of the mandible. [1] The Mf curves downwards and forwards into the body of The Mandibular foramen (Mf) is present on the the mandible to form the mandibular canal inner surface of the ramus of the mandible. It which exit opens into mental foramen. The leads into the mandibular canal giving passage Inferior Alveolar Nerve (IAN) and vessels to Inferior Alveolar Nerve (IAN) and vessels pass through it which supplies the which enter the roots of the teeth and the periodontal septa. Many unnamed accessory mandibular teeth, which runs further down foramina are present on the lingual side of the in the mandibular canal to emerge out from [2] mandible which are very variable in their the mental foramen. distribution but they are observed more often on Any other openings in the mandible the internal surface of the mandible in position other than Mf, sockets of teeth, mental above or below the MF. A dental surgeon foramen and lingual foramen are labelled as performing tooth extraction should be aware of Accessory Mandibular foramen (AMf). [3] Accessory Mandibular Foramina (AMf) for The incidence of AMf has been planning anaesthesia at an appropriate found to be greater on the medial surface anatomical site as the branches of the facial than on the lateral surface. [4,5] nerve, mylohyoid nerve, buccal nerve and Many unnamed accessory foramina transverse cervical cutaneous nerve are known to pass through these foramina. Nerve block are present on the lingual side of the techniques by local anaesthetics might fail if any mandible which are very variable in their of these nerves or their branches pass through distribution but they are observed more these AMf and escape the nerve block. The often on the internal surface of the mandible present research paper reports the presence of in position above or below the mandibular AMf around Mf in 25 dry human mandibles out foramen. [6] of 100 mandibles studied and emphasizes the These foramina were studied inter-relationship between Mf and AMf in immuno histochemically and proved that certain cases studied radiologically. Precise their contents included an artery and a knowledge and awareness of such AMf would nerve. Injecting an anaesthetic solution into therefore be important for dental surgeons the pterygomandibular region, where the performing nerve block and also for oncologists in planning radiation therapy. IAN is found in the Mf, is an anaesthetic technique which is commonly employed in Key Words: Accessory mandibular foramina, the dental clinics. It was reported that the mandibular foramen, mandibular canal, nerve local anaesthesia which was given during block. dental extractions might fail, if the branches of IAN pass through these accessory INTRODUCTION foramina and thus escape the drug. [7-9] The Mandibular foramen (Mf) is an Awareness of the presence of AMf irregular foramen which is located just may be important in achieving successful above the centre of the medial surface of the IAN anaesthesia and so this is best Galore International Journal of Health Sciences and Research (www.gijhsr.com) 1 Vol.3; Issue: 3; July-September 2018 Sakshi Mathur et.al. An Anatomico-Radiological Study of Inter-Relationship between the Mandibular Foramen and Accessory Mandibular Foramina in Population of Rajasthan State performed at a higher level using the Procedure of OPG:- technique also known as the “Gow-Gates I. An OPG which stands for technique”. [10] “Orthopantomogram”, gives a This procedure involves the panoramic view of the mouth, giving administration of the anaesthetic solution at information on the teeth and the a higher level before the division of the bones of the upper and lower jaw. mandibular nerve. [11] II. An OPG machine (Fig. 2) is The presence of anatomical specifically designed to produce X- variations in human mandible such as the rays of the teeth, jaws and AMf, presents clinical implications, if not temporomandibular joints. The previously identified, can cause image provides an overview of the complications to clinical dental practice. [12] state of the dentition, as well as Furthermore, failures in the information regarding the bones of anaesthesia by regional blockage of the IAN the jaw (the mandible and maxilla), are reported due to the presence of these the air sinuses in the upper jaw and foramina. [13] the joints between the jaw and the Knowledge of the anatomical details skull (the temporomandibular of AMf may then be of significant clinical joints). interest to surgeons and oncologists in III. During the procedure, the patient’s clinical practice. chin is placed on a ‘chin rest’. The Therefore, the aim of present study jaws are held in place by biting was to radiologically analyse the inter- down on a small disposable plastic relationship between the Mandibular guide. Most OPGs are performed Foramen (Mf) and Accessory Mandibular with the patient standing. An OPG Foramina (AMf) in dry human mandibles of aims to view the jaw, while blurring Rajasthan State. out the other structures of the face and skull. This is done using a MATERIALS AND METHODS technique called "tomography". The present study included 100 dry During the exposure, the X-ray tube human mandibles procured from the and film cassette rotate around the Department of Anatomy, Mahatma Gandhi jaws. As the X-ray tube moves Medical College & Hospital, Jaipur, the around the head, the x-ray film Department of Anatomy, SMS Medical moves in the opposite direction College & Hospital, Jaipur, the Department behind the head. of Anatomy, NIMS Medical College & IV. An exposure lasts a few seconds Hospital, Jaipur. during which time the patient must The mandibles were examined for remain still. The film cassette is then the presence of AMf around the Mf and 25 removed to allow development of out of 100 mandibles reported the presence the exposed X-ray film. of AMf. V. This generates an image where the Out of the 25 mandibles with AMf mandible and teeth are in focus, and incidences, 8 mandibles were selected for the other structures are blurred. detailed radiological analysis and VI. OPG procedures can take up to 15 interrelationship between Mf &AMf was minutes. studied after inserting probed wire in While performing OPGs for the respective canals/foramina (Fig. 1). purpose of present study, the dry mandibles For this purpose, OPG of mandibles with inserted probed wire in the with AMf incidences was undertaken. canals/foramina were fixed on the ‘chin rest’ (Fig. 3) one by one by using surgical tape for proper adhesion. After that, the Galore International Journal of Health Sciences and Research (www.gijhsr.com) 2 Vol.3; Issue: 3; July-September 2018 Sakshi Mathur et.al. An Anatomico-Radiological Study of Inter-Relationship between the Mandibular Foramen and Accessory Mandibular Foramina in Population of Rajasthan State above mentioned procedure of OPG (Fig. 4) was conducted repeatedly and images were thus obtained for studying the interrelationship between Mf and AMf. Fig.4:- Picture showing the different positions of an OPG Fig.1:- Picture showing a mandible with inserted probed wires procedure being undertaken. in the Mf and AMf to study the interrelationship between them. RESULTS The details of mandibles with incidences of AMf which have undergone the procedure of OPG have been depicted in tabulated form in the Table 1:- Table 1:- Details of radiologically analysed mandibles with AMf incidences. S.No. of No. of Accessory Mandibular Radiographically studied Foramina (AMf) Fig.2:-An OPG machine with mandible placed over the ‘chin Mandibles rest’. Right half Left half 1. 1 4. 2 7. 1 8. 1 16. 1 1 17. 1 18. 1 1 23. Fig.3:- Picture showing the adhesion of mandible by using surgical tape on the ‘chin rest’ of the OPG machine. Fig.5:-Mandibles with incidences of AMf. Probed wire has been inserted in the Mf &AMfs of the respective mandible. After conduction of OPGs of the ray digital images were obtained for the above mentioned mandibles (Fig. 5) the X- purpose of studying the interrelationship Galore International Journal of Health Sciences and Research (www.gijhsr.com) 3 Vol.3; Issue: 3; July-September 2018 Sakshi Mathur et.al. An Anatomico-Radiological Study of Inter-Relationship between the Mandibular Foramen and Accessory Mandibular Foramina in Population of Rajasthan State between Mf and AMf and thus the following observations were made:- I. Mandible No. 1:- Here, the AMf was single and present on the right half of the mandible. The probed wires had been inserted in the Mf and AMf of the right half. It was observed that the probed wires inserted in the respective foramina traverses within Fig. 6(b):- The wire already present inside the mandible the mandible through same canal superimposes with the probed wire inserted through the Mf of and thus superimposes to form a left half. single mandibular canal [Fig. 6(a)]. II. Mandible No. 4:- Here, the AMf were double and present on the left half of the mandible. The probed wires had been inserted in the Mf and the two AMf (AMf 1 &AMf 2) of the left half. It was observed that the probed wires inserted in the Mf and AMf 2 traverses within the mandible through separate canals and do not superimpose to form a single mandibular canal whereas the Fig. 6(a):- The probed wires inserted in the respective foramina traverses within the mandible through same canal probed wire inserted in AMf 1 and thus superimpose to form a single mandibular canal.