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      Comprehensive review of the incisive branch of the inferior alveolar nerve

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          Abstract

          The incisive branch of the inferior alveolar nerve is a vital anatomical structure within the anterior mandible that has not been thoroughly defined and outlined in reports in the literature until recent years. Advances in radiological imaging, particularly the widespread use of cone-beam computed tomography has allowed for accurate visualization of the mandibular incisive canal (MIC) and its associated incisive branch of the inferior alveolar nerve. Surgical damage to the MIC, which could result in hemorrhage and sensory disturbance, may occur in commonly practiced oral and maxillofacial procedures, such as chin bone harvesting, implant placement, fracture repair and removal of pathologic entities of the anterior mandible. Knowledge of both the presence, dimensions and location of the incisive branch is a vital component to pre and peri-operative planning of oral and maxillofacial surgeries performed within the mandible, particularly within the interforaminal zone. In this article, the terminology, anatomy, imaging, surgical consideration, and pathology of the incisive branch will be discussed.

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          Most cited references42

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          Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors

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            Morbidity of harvesting of chin grafts: a prospective study.

            In a prospective study, 20 patients who underwent harvesting of chin grafts as outpatients, were followed up for 12 months (3 further patients with incomplete follow-up data were excluded from the study). Preoperatively and 7 days, 1, 3, 6 and 12 months postoperatively, follow-up data were assessed. Evaluation of the superficial sensory function of the inferior alveolar nerve was determined by the Pointed-Blunt Test and the Two-Point-Discrimination Test. Sensory disturbances were objectively assessed by testing thermal sensitivity with the "Pain and Thermal Sensitivity" Test (PATH Test). In addition, evaluation of the pulp sensitivity of teeth 35-45 was carried out by cold vitality testing. One week postoperatively, 8 patients were affected by superficial sensory impairment. 8 nerve territories showed hypoaesthetic reactions and 5 showed hyperaesthetic reactions. After 12 months, two patients still suffered from hypoaesthesia of one side of the chin. There was a statistically significant sensitivity impairment of the chin for all patients comparing the preoperative data of the Two-Point-Discrimination Test (left/right median: 8.17/8.17 mm, interquartile range (IQR) 1.00/2.00 mm) with the first postoperative measurement (left/right median 9.00/8.33 mm, IQR 1.67/2.66 mm). Comparing the latter to the last postoperative measurement there was significant tendency for regeneration of a nerve function (left/right median 8.00/7.84 mm, IQR 0.66/2.00 mm). In the PATH Test all hypoaesthetic areas could be identified by a reduction of thermal sensitivity. After the first postoperative examination 21.6% (n=38/176) of the examined teeth had lost their pulp sensitivity. After 12 postoperative months 11.4% (n=20/176) still did not react sensitively. Many of these were canines (n=8/20). Comparing the preoperative to the first postoperative examination, there was a significant reduction of pulp sensitivity. However, statistically significant recovery until the last postoperative follow-up could not be detected. The assessed data show that patients have to be informed extensively about disturbances of the inferior alveolar nerve function lasting longer than 12 months. Moreover, the loss of pulp sensitivity is a very frequent event which has always to be taken into account. Considering the high rate of complications with harvesting of chin grafts, more prospective trials should be done to find out whether there are other donor sites for autogenous bone which put less strain on patients.
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              The anterior loop of the inferior alveolar nerve: prevalence, measurement of its length and a recommendation for interforaminal implant installation based on cone beam CT imaging.

              Interforaminal implant surgery requires anatomical knowledge of the area and adequate information on the location of the various landmarks of significance such as the mental foramen, the anterior loop of the inferior alveolar nerve and the mandibular incisive canal. Cone beam computed tomography (CBCT) is a relatively new imaging modality that provides a multi-dimensional view of the facial skeleton with, in most instances, lower radiation dose to the patient compared to medical CT. The present study aims to use CBCT to identify and measure variation in the presence and extent of the anterior loop of the inferior alveolar nerve. This information may be used to provide recommendations to the surgeon without access to a 3D scan of the dento-alveolar region.
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                Author and article information

                Journal
                Anat Cell Biol
                Anat Cell Biol
                Anatomy & Cell Biology
                Korean Association of Anatomists
                2093-3665
                2093-3673
                31 December 2021
                31 December 2021
                31 December 2021
                : 54
                : 4
                : 409-416
                Affiliations
                [1 ]Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA, USA
                [2 ]Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
                [3 ]Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
                [4 ]Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
                [5 ]Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
                [6 ]Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada
                [7 ]Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
                [8 ]Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
                [9 ]Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
                [10 ]Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
                [11 ]Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
                Author notes
                Corresponding author: Joe Iwanaga, Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA 70112, USA, E-mail: iwanagajoeca@ 123456gmail.com
                Author information
                https://orcid.org/0000-0003-2868-5470
                https://orcid.org/0000-0002-2765-937X
                https://orcid.org/0000-0002-1990-9308
                https://orcid.org/0000-0002-3599-1671
                https://orcid.org/0000-0002-6135-1053
                https://orcid.org/0000-0003-1317-1047
                https://orcid.org/0000-0002-8502-7952
                Article
                acb-54-4-409
                10.5115/acb.21.113
                8693131
                34620736
                45efdd65-a5e2-4dd0-9bde-77fafa9136d3
                Copyright © 2021. Anatomy & Cell Biology

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 2 June 2021
                : 1 July 2021
                : 13 July 2021
                Categories
                Review Article
                Applied Anatomy

                Cell biology
                mandible,incisive canal,dental implants,oral surgery,cone-beam computed tomography
                Cell biology
                mandible, incisive canal, dental implants, oral surgery, cone-beam computed tomography

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