Research Article

Bifid Mandibular Canals: A case report and mini review

Sourav Sarkar* and Saini Mondal

Published: 04/03/2020 | Volume 4 - Issue 1 | Pages: 006-008

The presence of bifid mandibu¬lar canals is an unusual but not rare occurrence. The mandibular canal containing the inferior alveolar artery, vein, and nerve, originates from the mandibular foramen and terminates at mental foramen [1-4]. In radiology, mandibular canal’s appearance has been described as “a radiolucent dark ribbon between two white lines”[5]. White and Pharoah defined it as “dark linear shadow with thin radiopaque superior and inferior borders cast by the lamella of bone that bounds the canal” [6]. Understanding of its anatomic variations is very important due to its clinical implications in various oral and maxillofacial treatments like removal of wisdom teeth [7], mandibular implant placement [8], in bilateral sagittal split osteotomy procedures and during fixation of mandibular fractures. Presence of bifid or multiple mandibular canals forces the clinician to change the treatment plan. Ignoring this variation can cause several complications intra or postoperatively or even result in failure of treatment. For instance a bifid canal if ignored during surgical removal of third molar or dental implant placement can cause prolonged pain even after administering local anesthesia and also severe bleeding if the accessory canal is encroached [2].

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References

  1. Carter RB, Keen EN. The intramandibular course of the inferior alveolar nerve. J Anat. 1971; 108: 433-440. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/5575310
  2. Moiseiwitsch JRD. Position of the mental foramen in a North American, white population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 457-460. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9574957
  3. Wadu SG, Penhall B, Towsend GC. Morphological variability of the human inferior alveolar nerve. Clin Anat. 1997; 10: 82-87. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9058013
  4. Nikzad S, Azari A, Sabouri S. Double mandibular foramina and canal: report a case with interactive CT-based planning software. Iran J Radiol. 2008; 5: 83-86.
  5. Worth HM. Normal radiographic appearances of the teeth and jaws and variations within the normal. Principles and Practice of Oral Radiologic Interpretation. Chicago, IL: Year Book Medical Publishers, Inc.; 1963; 15‑79.
  6. White SC, Pharoah MJ, editors. Oral Radiology, Principles and Interpretation. 5th ed. St. Louis, Missouri: Elsevier; 2006; 184.
  7. Ghaeminia H, Meijer GJ, Soehardi A, Borstlap WA, Mulder J, et al. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009; 38: 964–971. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19640685
  8. Worthington P. Injury to the inferior alveolar nerve during implant placement: a formula for protection of the patient and clinician. Int J Oral Maxillofac Implants. 2004; 19 :731–734. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15508990
  9. Nortje CJ, Farmen AG, Grotepass FW. Variations in the normal anatomy of the inferior dental (mandibular) canal: a retrospective study of panoramic radiographs from 3612 routine dental patients. Br J Oral Surg. 1977; 15: 55-63. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/268217
  10. Langlais RP, Broadus R, Glass BJ. Bifid mandibular canals in panoramic radiographs. J Am Dent Assoc. 1985; 110: 923-926. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3860553
  11. Devito KL, Tamburús JR. Anatomy of the mandibular canal: radiological classification of its variations. Rev Assoc Paul Cir Dent. 2001; 55: 261-236.
  12. Rossi PM, Brücker MR, Rockenbach MIB. Bifid mandibular canals: panoramic radiographic analysis. Rev Cienc Med. 2009; 18: 99-104.
  13. Rouas P, Nancy J, Bar D. Identification of double mandibular canals: literature review and three case report with CT scans and cone beam CT. Dentomaxillofac Radiol. 2007; 36: 34 38. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17329586
  14. Naitoh M, Hiraiva Y, Aimiya H, Ariji E. Observation of bifid mandibular canal using cone beam computerized tomography. Int J Oral Maxillofac Implants. 2009; 24: 155-159. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19344041
  15. Kuribayashi A, Watanabe H, Imaizumi A, Tantanapornkul W, Katakami K, et al. Bifid mandibular canals: cone beam computed tomography evaluation. Dentomaxillofac Radiol. 2010; 39: 235-239. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20395465s
  16. Fu E, Peng M, Chiang CY, Tu HP, Lin YS, et al. Bifid mandibular canals and the factors associated with their presence: a medical computed tomography evaluation in a Taiwanese population. Clin Oral Implants Res. 2014; 25; e64-e64. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23130919
  17. de Oliveira-Santos C, Souza PH, De Azambuja Berti-Couto SA, Stinkens L, Moyaert K, et al. Assessment of variations of the mandibular canal through cone beam computed tomography. Clin Oral Investig. 2012; 16: 387-393. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21448636
  18. Sanchis JM, Peñarrocha M, Soler F. Bifid mandibular canal. J Oral Maxillofac Surg. 2003; 61: 422-424. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12684957
  19. Kim MS, Yoon SJ, Park HW, Kang JH, Yang SY, et al. A false presence of bifid mandibular canals in panoramic radiographs. Dentomaxillofac Radiol. 2011; 40: 434-438. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21960401
  20. Arensburg B, Nathan H. Anatomical observation of the mylohyoid groove, and the course of the mylohyoid nerve and vessels. J Oral Surg. 1979 Feb;37(2):93-6. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/105109
  21. Xie Q, Wolf J, Soikkonen K, Ainamo A. Height of mandibular basal bone in dentate and edentulous subjects. Acta Odontol Scand. 1996; 54: 379-383. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/8997437
  22. Auluck A, Pai KM, Shetty C. Pseudo bifid mandibular canal. Dentomaxillofac Radiol. 2005; 34: 387-388. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16227485
  23. Bogdan S, Pataky L, Barabas J, Nemeth Z, Huszar T, et al. Atypical courses of the mandibular canal: comparative examination of dry mandibles and x-ray. J Craniofac Surg. 2006; 17: 487-491. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16770186
  24. Wadhawani P, Mathur RM, Kohli M, Sahu R. Mandibular canal variant: a case report. J Oral Pathol Med. 2008; 37: 122-124. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/18197857
  25. Fukami K, Shiozaki K, Mishima A, Kuribayashi A, Hamada Y, et al. Bifid mandibular canal: confirmation of limited cone beam computed tomography findings by gross anatomical and histological investigations. Dentomaxillofac Radiol. 2012; 41: 460-465. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520398/