An Accessory Mental Foramen: A Case Report

Abstract

Aim The aim of this article is to present a case of an accessory mental foramen (AMF). Background The mental foramen is an important anatomical structure of particular importance in local anesthesia and surgical procedures in terms of achieving effective mandibular nerve blocks and avoiding injuries to the neurovascular bundles. Although rare, multiple mental foramina have been described in humans. In these cases one foramen is termed the mental foramen and the others are referred to as an AMF. Report A 62-year-old woman presented for a routine dental examination. In addition to the normal radiographic image of the mental foramen, periapical radiographs of the left mandibular premolar and molar region revealed a round-shaped radiolucency with distinct borders along with an inferior extension below the apex of the mesial root of the first molar. This image was considered to be an AMF. Summary Although no surgical operation was planned, the patient was informed about the existence and importance of the anatomical variation with regard to the need for local anesthesia, diagnosis of periapical disease, and the prevention of nerve damage during surgery in that area of the mandible. Citation Çağirankaya LB, Kansu HK. An Accessory Mental Foramen: A Case Report. J Contemp Dent Pract 2008 January; (9)1:098-104.

The clinical anatomy of accessory mental nerves and foramina

“…Terms such as double mental foramina (Igarashi et al, 2004;Arx et al, 2014), additional mental foramina (Santos et al, 2013), multiple mental foramina, accessory mandibular foramina (Patil et al, 2013) and accessory buccal foramina ) have been used to describe AMFs. Many authors have defined 'AMF' as any foramen in addition to the MF in the lateral body of mandible (Mraiwa et al, 2003;Prabodha and Nanayakkara, 2006;Ca girankaya and Kansu, 2008;Singh and Srivastav, 2011;Thakur et al, 2011;Gupta and Soni, 2012;Jha and Kumar, 2012;Ahmed et al, 2014;Paraskevas et al, 2014;Rai et al, 2014). Some have described an AMF as a small foramen in the area surrounding the MF (Riesenfeld, 1956;Sutton, 1974).…”

“…In the clinical setting, the presence of an AMN can cause difficulties during oral surgery such as apical surgery (Concepcion and Rankow, 2000;Arx et al, 2014), implant surgery (Kulkarni et al, 2011;Pancer et al, 2014), local anesthesia (L opez and Diago, 2006), trauma surgery (Ramadhan et al, 2010;Mamatha et al, 2013), and neurectomy (Ca girankaya and Kansu, 2008;Jha and Kumar, 2012). Arx et al (2014) described four cases of apical surgery in which an AMN was present.…”

Characterisation of additional mental foramina through cone beam computed tomography

“…The human MF presents typically as a single opening on each side of the mandible. However, in some cases, multiple foramina may be observed (4,(7)(8)(9). Rare cases of MF absence have been reported (10)(11)(12).…”

Characteristics of Accessory Mental Foramina Observed on Limited Cone-beam Computed Tomography Images

“…Concepcion et al (14) encountered an accessory branch of mental nerve adjacent to the MF during flap reflection in a periapical surgery. Çagi-rankaya et al (15) presented a case of AMF below the apex of the first molar demonstrated with intraoral radiographies for periodontal treatment.…”