Original Research Article AN INSIGHT TO THE … · Lekshmy Vijay. V.G, Ramakrishna Avadhani,...

Int J Anat Res 2017, 5(3.3):4343-48. ISSN 2321-4287 4343

Original Research Article

AN INSIGHT TO THE ANTHROPOMETRIC STUDY OF MENTAL FORA-MEN OF JAW BONE WITH RESPECT TO ITS SURGICAL IMPORTANCELekshmy Vijay. V.G 1, Ramakrishna Avadhani 2, Qudusia Sultana *3.

ABSTRACT

Address for Correspondence: Dr. Qudusia Sultana, Assistant Professor, Department Of Anatomy,Yenepoya Medical College, Mangaluru, Karnataka, India. E-Mail: [email protected]

Background: Mental foramen is one of the two foraminas situated on the anterolateral aspect of the body ofmandible below the interval between the premolar teeth. They are slightly lower in edentulous individuals, whichgives path for mental nerves and vessels. Morphological and morphometric parameters of mental foramen inrelation to surrounding landmarks is clinically important, for providing a suitable data for dental surgeons andanaesthetics for an effective mental nerve block anaesthesia and for avoiding post-surgical complications dueto nerve damage. This also helps for age estimation in fossil study. The following parameters were assessed todetermine the distance of mental foramen from them; a) Alveolar crest, b) Lower border of mandible, c) Symphysismenti, d) Posterior border of ramus, e) Angle to foramen. Shape of foramen and level of teeth where the foramenis situated were also assessed.Materials and Methods: This study was carried out in the Department of Anatomy, Yenepoya Medical College. Atotal of 102 dry human mandibles for location of mental foramens from various landmarks were studied usingdigital vernier calliper.Results and Discussion: The mean and standard deviation values are as follows. The distance of mental foramenfrom its alveolar crest is 10.18±3.18, lower border is 12.62±1.67, symphysis menti is 26.12±5.35, posteriorborder of ramus is 61.11±6.34, angle of mandible is 40.79±4.56, from alveolar crest to lower border of mandibleis 22.8±3.78. Foramen was observed to be round in shape in 70% of cases and majority were seen at 2nd premolarlevel.Conclusion: These variations are of diagnostic importance for dental surgeons during nerve block, periodontalsurgeries and to avoid injuries to neurovascular bundle. Awareness of possibility of the anatomical variationswhile planning surgery to avoid nerve damage .KEY WORDS: Mental foramen, Human mandible, Shape, Position, Location.

INTRODUCTION

International Journal of Anatomy and Research,Int J Anat Res 2017, Vol 5(3.3):4343-48. ISSN 2321-4287

DOI: https://dx.doi.org/10.16965/ijar.2017.330

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1 Post Graduate, Department of Anatomy, Yenepoya Medical College, Mangaluru, Karnataka, In-dia.2 Professor and HOD, Department of Anatomy, Yenepoya Medical College, Mangaluru, Karnataka,India.*3 Assistant Professor, Department of Anatomy, Yenepoya Medical College, Mangaluru, Karnataka,India.

Received: 05 Jul 2017Peer Review: 06 Jul 2017Revised: 02 Aug 2017

Accepted: 16 Aug 2017Published (O): 30 Sep 2017Published (P): 30 Sep 2017

between upper and lower borders of the bone[1]. Normally it is located externally below theinterval between the premolars [2], which gives

Mental foramen is situated on the anterolateralaspect of the body of mandible in the midway


path to mental nerves and vessels [3,4].Variations of mental foramens are often encoun-tered ranging from difference in shape andpositions [5,6,7] to the presence of accessoryforamen[8], or complete absence as mentionedin some cases [9,10]. The mental nerve andvessels radiate through the mental foramen andsupply sensory innervation and blood supply tothe soft tissues of the chin, lower lip and gingi-val on the ipsilateral side of the mandible.Additionally, local anaesthesia of the terminalincisive branches of the inferior alveolar andmental nerves can be obtained effectively if themental foramen is correctly identified. There-fore, computerized tomography (CT) is moreaccurate for detecting the mental foramen thanconventional radiographs reported by SonickM.et al [11].The position of mental foramen has beenstudied by means of direct measurement on drymandibles or by using radiographs of drymandibles or in patients [12-14]. Standardanatomical [15] and radiological text books [16]contain conflicting statements regarding thelocation of mental foramen. The mental fora-men is an important anatomical landmark tofacilitate dental surgical, local anaesthetic andother invasive procedures [17] in accordance toits variations in the position, shape, size andpresence of accessory mental foramen.Knowledge of variations of mental foraminasrequired as many dental surgical procedures onthe mandible such as; curettage of premolars,filling procedures, implantation, root canal treat-ments and orthodontic surgeries [18] are highlyrelated with the position of mental foramen.Aim: The current study is done to analyzemorphological and morphometric features ofmental foramen in dry adult human mandiblesin South Indian population in relation to surround-ing landmarks which may furnish a reference fordentists in clinical practices.Objectives: To evaluate the shape and positionof the mental foramen, To assess the locationof mental foramen with relation to various land-marks on the mandible

and age obtained from the Department ofAnatomy, Yenepoya Medical College formed thematerial for study. We observed the position ofmental foramen with respect to teeth, its shape,and its location with respect to borders werenoted.Morphometric measurements of mental fora-mens in dry human mandibles, with or withoutintact teeth, with preserved alveolar margins,were used for our study. Bones with gross patho-logical deformities were excluded from ourstudy.Before measuring, mandibles were placed on astandard horizontal plane to which the lowerborder of mandible get its most contact whenvertical pressure is applied to the molars[6,19,20]. The mandibles were observed mac-roscopically for the presence of mental foramen.The data obtained was tabulated and analyzedby descriptive statistics using the SPSS softwarepackage for windows version 22.0. All the mea-surements were recorded by one of the authorsto reduce bias.We measured the distance of MF (in mm) fromvarious landmarks including alveolar crest,lower border of mandible, symphysis menti andposterior border of the ramus of mandible withdigital vernier caliper were calculated[21] (Fig-ure 1).A-F : distance of alveolar crest to the uppermargin of mental foramen.B-F : distance from lower border of mandible tothe lower margin of mental foramen.C-F : distance from symphysis menti to medialmargin of mental foramen.D-F : distance from posterior border of ramus ofmandible to lateral margin of mandible.

MATERIALS AND METHODS

102 dry adult human mandibles of unknown sex

RESULTS

Shape: The shape of MF was visually recognisedand analysed. Out of 102 mandibles (204 sides),round in contour was more prevalent [68 (67%)on right side and 75(74%) on left side] followedby oval contour [34 (33.3%) on right side and 27(26.5%) on left side] (Figure 2,3).The position of MF was classified in relation toteeth of the lower jaw in accordance with Teboand Telford [22] (Figure 4).

Lekshmy Vijay. V.G, Ramakrishna Avadhani, Qudusia Sultana. AN INSIGHT TO THE ANTHROPOMETRIC STUDY OF MENTAL FORAMEN OFJAW BONE WITH RESPECT TO ITS SURGICAL IMPORTANCE.


Foramen lying on a longitudinal axis through thefirst premolar;Foramen lying on a longitudinal axis passingbetween first and second premolar;Foramen lying on a longitudinal axis throughsecond premolar;Foramen lying on a longitudinal axis passingbetween first molar and second premolar; Fora-men lying on a longitudinal axis through the firstmolar;Foramen lying on a longitudinal axis passingbetween first and second molar

Table 1: Position of right and left mental foramina.

Frequency Percent Frequency Percent II Premolar 46 45.1 48 47.1I Molar 20 19.6 18 17.6Between I Molar & II Premolar 15 14.7 16 15.7Between I & II Premolar 12 11.8 12 11.8 I Premolar 7 6.9 7 6.9Between I & II Molar 2 2 1 1Total 102 100 102 100

Right Left

Mean Standard deviation

Mean Standard deviation

Left LOCATION

Right

3.19817 10.2726 3.16241

12.4751 1.72646 12.7805 1.62377

A-F (Alveolar Crest to foramen)

B-F (Lower border to foramen)

C-F (Symphysis Menti to foramen)

D-F (Posterior border of ramus to foramen)

25.3068 1.93339 26.9457 7.24332

59.4663 7.11347 62.7679 4.99048

10.0853

Table 2: Parameters to locate the right and left mentalforamina from the prominent landmarks.

Table 3: Comparison of results of earlier studies withthe present study with respect to shape of mentalforamen.

Oval Round Oval Round Present study South Indians 33.30% 66.70% 26.50% 73.50%Akhilandeswari and Priya (2016) [26] South Indians 55.10% 44.90% 50.60% 49.40%Singh and Srivastav (2010) [23] North Indians 6% 94% 13% 87%Junior et al. (2009) [24] Brazilian 73.80% 21.20% 71.30% 28.70%Souaga et al. (2004) [25] Africans 73.80% 26.20% 100% 0%

Author Population Right side Left side

Fig. 1: Relation of mental foramen to the body ofmandible.

Fig. 2: Mental foramen in round shape.

Fig. 3: Mental foramen in oval shape.

Fig. 4: Variable relations of mental foramen to lowerteeth (M-molars, PM-premolars, C-canine).

Position: The most frequent position of mentalforamen was in line with the apex of secondpremolar teeth (position-III) in the present study(46 (45%) on right side and 48 (47%) on left side)[(Figure 4),(Table 1)] followed by first molarposition-V, position-IV, position-II, position-I,position-VI.



Table 4: Comparison of present study with similar studies by different groups with respect to the position of mentalforamen in relation to teeth.

I II III IV V VI

(1 Pre molar) (btw 1 & 2 Pre molar)

(2 Pre molar) (btw 1 Molar & 2 Pre molar)

(1 Molar) (1 &2 Molar)

Right 6.9 11.8 45.1 14.7 19.6 2Left 6.9 11.8 47.1 15.7 17.6 1

Right 0 7.8 81.5 2.7 7.9 0Left 0 7.6 81.5 3.1 7.8 0

Right 5.7 34.3 55.7 4.3 0 0Left 7.1 25.7 61.4 5.7 0 0

Right 0 19.8 71.4 8.8 0 0Left 0 23.1 68.1 8.8 0 0

Position of foramen (in percent)

Authors Population Side

Present study

Yesilyurt et al. (2008) [20] Turkish

Amorim et al. (2008) [19] Brazilian

South Indian

Central Indian Agarwal and Gupta (2011) [5]

Table 5 : Comparison of the location of mental foramen from the prominent landmarks.

Right Left Right Left Right Left Right LeftPresent study 10.08±3.19 10.27±3.16 12.47±1.72 12.78±1.62 25.30±1.93 26.94±7.24 59.46±7.11 62.76±4.99

Shukla RK. et al 2015 [31] 10.84±2.94 10.69±4.83 15.02±9.94 13.88±1.59 25.72±3.24 26.19±4.79 64.61±4.4 65.05±4.14Udhaya K. et al 2013 [18] 12.02±2.48 12.21±2.61 12.65±1.59 12.77±1.73 25.79±1.78 25.29±2.29 63.92±4.26 64.51±4.06

Virendra B. et al 2013 [17] 29.30±0.36 29.20±0.31 15.25±0.24 15.40±0.22 25.39±0.66 25.29±0.30 65.76±0.70 66.13±0.77

AUTHORA - F B - F C - F D - F

Location: The statistical analysis of position ofMF and its size in relation with borders in leftside is presented in the Table-2. The distanceofA-F was 10.27±3.16 mm in left side. However,B-F was 12.78±1.62 mm in left side. The dis-tance of C-F was observed to be 26.94±7.24 mmin left side and D-F was 62.76±4.99 (Table 2).The statistical analysis of position of MF and itssize in relation with borders in right side ispresented in the Table-3. The distance of A-Fwas 10.08±3.19 mm in right side. However, B-Fwas 12.47±1.72 mm in right side. The distanceof C-F was observed to be 25.30±1.93 mm inright side and in D-F was 59.46±7.11 mm (Tab.2).

would facilitate the dental surgeons to applynerve block in different surgical procedures in-volving the lower jaw.Shape: Mental foramen was seen oval in con-tour among various geographical populations.Comparison of the percentages of oval andround shapes were recorded in the present studywith that of the previous studies have been high-lighted in Table 3. Singh and Srivastav; 2010[23]reported round contour of mental foramenamong a study conducted in North Indian drymandible specimens (94% on right side and 87%on left side among 200 specimens), which issimilar to that of our studies. The present studyon South Indian mandibles also projects the pres-ence of round shape of mental foramina morethan that of oval shape. Studies of Akhilande-swari; et al 2016 [26], among South Indian popu-lation showed more prevalence of oval contourof mental foramen. This is contradictory to thepresent study. But, position of mental foramenwas not a study objective by the above men-tioned authors.Position: There are significant differencesreported in the position of MF among differentethnic groups. Igbigbi and Lebona [21] inMalawians and Mbajiorgu et al. [27] in Zimba-bweans mandibles reported position III as thecommonest one, followed by position IV;however, Santini and Land [6] in British and

DISCUSSION

MF is usually a single opening seen on each sideof the body of mandible. In some cases, theremay be complete absence of MF or it may be inmultiples [15]. Variations of mental foramenwere reported in different races in differentgeographic populations. They were having sameor different age, sex and ethnicity; which wereassessed using dry human mandible or byradiographic studies.Different anatomy and radiology textbooks givecontradicting statements regarding the morpho-metric characteristics of the mental foramen;thereby depicting variable racial trends [6].Location, shape and position of mental foramen



Green [28] in Chinese mandibles observedposition II being the commonest followed byposition III.In other studies on Kenyans mandibles [29], theposition II was found most common followed byposition I and in Malay populations [30] the mostcommon position was III followed by II, but inthe above-mentioned studies right and left sideswere not considered separately from each other.Our study observed the IIIrd position of mentalforamen (2nd premolar) were prevalent whichwas same as the studies of Agarwal and Gupta;2011[5] among 100 dry mandibles of CentralIndia (Table 4). But the studies on other differ-ent geographical regions were not similar withthe present study.Variability in MF position may be related to dif-ferent feeding habits subsequently affectingmandibular development [20]. Prior knowledgeof common positions in local populations maybe helpful in effective nerve blocks and surger-ies in those regions.Location: Comparison of the location of men-tal foramen from the prominent landmarks isidentified in the present study with other stud-ies as shown in Table 5 respectively. The loca-tion of mental foramen was found to be morecloser to A–F in the present study. The compara-tive study was also showing almost the sameresults for the location parameter assessment.

CONCLUSION

orientation, shape, appearance and relation withteeth on lower jaw in different populationgroups. Therefore; it is essential to be aware ofthe possibility of these anatomical variationswhile planning surgery in that specific region toavoid nerve damage. This is also to enableeffective mental nerve block anaesthesia. A priorCT scan can elucidate jaw structures andprevent patient morbidity.Therefore, a detailed knowledge of the mentalforamen and it’s variation in different popula-tion is essential for dentists, orthopedicians andanatomists. Also the knowledge about thedirection of opening is important for dentistswhile doing mental nerve block.

Prior knowledge of mental foramen variationshelps surgeons in planning surgery in thatregion to avoid nerve damage and also enableeffective mental nerve block anaesthesia whileplanning for closed surgeries.Mental nerve paralysis is one of the principalcomplications of surgeries of the mentalforamen regions. Mental foramen variationsremain unnoticed and undiagnosed. In order toobtain effective nerve block and to avoid postprocedural neurovascular complications in themental region, particular attention should bepaid to the morphology of the mental foramen.The present study suggests, majority of themandibles have found round shaped foraminalying in the apex of IInd premolar teeth.However, the variations do exist in the location,

ACKNOWLEDGEMENTS

Authors would like to thank Mrs. Megha H. Nair(Statistician) and Department of Anatomy fortheir support in the above study.

Conflicts of Interests: None

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How to cite this article:Lekshmy Vijay. V.G, Ramakrishna Avadhani, Qudusia Sultana. ANINSIGHT TO THE ANTHROPOMETRIC STUDY OF MENTALFORAMEN OF JAW BONE WITH RESPECT TO ITS SURGICALIMPORTANCE. Int J Anat Res 2017;5(3.3):4343-4348. DOI:10.16965/ijar.2017.330


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