Mandibular canal, foramina of the mandible and their variations: part II: the clinical relevance of the preoperative radiographic evaluation and report of five cases

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In part I of the article, a detailed description of the anatomical variations of the mandibular canal and the foramina of the mandible was given. The aim of part II is to discuss the clinical relevance of the anatomical variations.

Materials and methods:

A literature review was carried out, and five cases of mandibular canal variations are reported.


Anatomical variations of the mandibular canal and foramina of the mandible are reported in bibliography. Bifid and double mandibular canals have been firstly reported in 1973. Since then, the anatomical variations of the mandibular canal have been described by case reports, cadaveric and retrospective radiological studies. It has been proved that the inferior alveolar nerve gives communication fibers to other nerves and extraosseous branches, before entering the mandibular canal, whereas even if it enters the mandible, it branches during its course into the canal. Also, the supplementary innervation of mandibular teeth and periodontal tissues by the long buccal and mylohyoid nerves has been suggested. Several authors also reported the existence of retromolar foramen and supplementary buccal and lingual foramina and their important role either in vascularisation or innervation.


The neurovascular contents of the mandibular canals and foramina gain more importance in oral surgery and implantology because these components are vulnerable to damage during implant placement and sagittal split osteotomy surgery, and complications may occur during the surgery (i.e. unsuspected bleeding, nerve injury). Also, clinicians should be aware of accessory foramina or canals of the mandible in understanding failed inferior alveolar nerve block.

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