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Medial view of the ramus of mandible. (a) Illustration of the height of the lingula (h). (b) Illustration of the distances measures: MN-L, A-L, P-L, and MB-L.
Source publication
Objectives:
The purpose of this research was to study, in macerated adult human mandibles, the height of the lingula and provide morphometric data for its location considering aspects such as shape of the lingula, gender, and race.
Material and methods:
132 macerated mandibles of Brazilian adult individuals, both sexes, Amerindian and Caucasian,...
Citations
... Our study demonstrated that the LG was not always located on the same position as the AL on the lateral side. Moreover, the morphology of the LG has been shown to be diverse among genders and racial groups [28,29]. Tuli et al. [30] classified such variations into 4 types: truncated, triangular, nodular and assimilated. ...
Background
The antilingula located on the lateral surface of the mandibular ramus has been served as a surgical landmark for the mandibular foramen on the medial surface for decades. However, whether the antilingula truly represents the lingula which is the bony prominence overlapping the mandibular foramen, or the foramen itself, is still unclear. This study thus aimed to examine the position of the antilingula in relation to three reference points: the lingula, the anterior and the posterior borders of the mandibular foramen, as well as to the reference plane used in the inferior alveolar nerve block, and to the posterior border of the mandible.
Methods
This observational study was performed in 113 Thai dry mandibles. The antilingula were identified followed by transferring the reference points to the lateral surface. The distances from the antilingula to the reference points, the reference plane and the posterior border of the ramus were then measured. Chi-square test was calculated for side-dependency of the antilingula. Paired t-test was calculated for difference in measurements in left and right sides.
Results
The antilingula could be identified in 92.48% of the mandibles with 86.67 – 90.00% accuracy and 86.67% reliability. There was no significant difference in the presence of the antilingula on left and right sides (p = 0.801). Only 2.5% and 0.83% of the antilingula correspond to the lingula and the anterior border of the mandibular foramen, respectively. However, 85% of the reference points were located within 11 mm radius. The antilingula was found located 2.80 mm inferior to the reference plane and 16.84 mm from the posterior border of the ramus.
Conclusions
The antilingula does not concur with the reference points on the medial surface. Our study also suggests that the safe area for vertical osteotomy is 11 mm posterior to the antilingula or at 30% of the length from the posterior border parallel to the occlusal plane. The use of more accurate techniques in localizing the mandibular foramen combined with the antilingula is more recommended than using the antilingula as a sole surgical guide.
... On the other hand, although there is no existing study showing the change in the localization of the lingula mandibulae according to pubertal status in different sexes, a few studies have focused on the localization of the lingula mandibulae in different sexes and population affinities. In their study, Alves & Deana (2015) investigated the location and shape of the lingula mandibulae and the relationship between rapopulation affinity and sex in males and females of Amerindians and Caucasians. Considering the anteroposterior position, they noted that the lingula mandibulae is positioned slightly behind the center of the mandibular ramus width. ...
... Also, regarding the superoinferior position, they stated that the lingula mandibulae is located in the upper or middle third of the ramus. In addition, as a result of the study, which detected various significant relationships between population affinity, sex, shape, and position of the lingula mandibulae and various distances, it was emphasized that the findings are important in terms of surgical procedures and inferior alveolar nerve anesthesia (Alves & Deana, 2015). In another study (Jansisyanont et al., 2009) evaluating the shape, height, and position of the lingula mandibulae in Thai human mandibles, it was determined that the lingula mandibulae was located above the occlusal plane in most of the human mandibles examined. ...
Objective
This study aims to investigate changes in lingula mandibulae localization before and after puberty and sex differences.
Design
288 panoramic radiographs evaluated retrospectively were divided into four groups according to pubertal development: under and over 10 years old for females and under and over 11 years old for males. Four anatomic sites were used as reference points: (a) the anterior border of the ramus; (b) the posterior border of the ramus; (c) the deepest point of mandibular notch; and (d) the angulus mandibulae. The ratio of the distances from the lingula mandibulae to points (a) and (b) and the ratio of the distances from the lingula mandibulae to points (c) and (d) were determined. Two-way ANOVA was performed to assess differences between subgroups based on sex and puberty, and a Bonferroni post-hoc test was performed for multiple comparisons.
Results
Puberty and sex has a significant interaction effect on the vertical location of the lingula mandibulae. Postpubertal lingula mandibulae is positioned proportionally more anteriorly by prepubertal localization. In addition, the lingula mandibulae is situated more posteriorly in females compared to males. A significant interaction effect of puberty and sex was observed in relation to the vertical positioning of the lingula mandibulae.
Conclusions
The spatial localization of the lingula mandibulae and its spatial displacement with age can be used both in estimating sex and the onset of puberty. Changes in the localization of lingula mandibulae according to pubertal development and sex can be used in forensic and anthropological contexts.
... Specific caution should be taken during sagittal split ramus osteotomy (SSRO) procedures, a technique related to the invasive correction of mandibular deformities [2]. In the SSRO procedure, the ML provides an anatomical landmark for a safe split, ideally for the horizontal osteotomy to be done superior to the ML and extend posteriorly in order to prevent IAN injury [7]. Another procedure that utilizes the ML and anti lingula (AL) as landmarks are the intraoral vertical ramus osteotomy (IVRO) [8], in which the bone must be cut superior and posterior to the apex of the ML. ...
... Eventually, 48 articles met the required criteria and were used in this meta-analysis [2,[4][5][6][7][8][9]. The overall data collection process can be found in Figure 4. ...
... Hsu et al. [56] also reported a predominance of bilateral symmetry among both the investigated dry mandible and CBCT study groups. With respect to gender-determining factors, Alves and Deana [7] claimed that the truncated type was found more commonly in women, while triangular was found more commonly in men. Unfortunately, due to a lack of sufficient data in the literature, we could not perform a statistical analysis of the variable anatomy of the ML with respect to the gender of the subjects. ...
Background: The objective of this meta-analysis was to investigate the anatomical variations
of the mandibular lingula (ML) and its relationship to surrounding anatomical structures.
Understanding such variations is crucial to help determine the site and depth of a successful
inferior alveolar nerve (IAN) anesthetic block as well as a safe area for oral and maxillofacial
invasive procedures in order to minimize the risk of neurological or hematological damage to
the inferior alveolar nerve.
Materials and methods: A systematic search was conducted in which all studies were
searched on the anatomy of ML. Major medical databases such as PubMed, Scopus, Embase,
Web of Science, Google Scholar, Cochrane Library were searched.
Results: All of the results were based on a total of 4694 subjects. The overall height of the
ML was found to be 8.17 mm (SE =0.22). The Triangular Type of the ML was found to be the
most common one. The pooled prevalence of this variation was found to be 29.33% (LCI =
23.57% ; HCI = 35.24%). The pooled prevalence of the Nodular Type was set to be 27.99%
(LCI = 22.64% ; HCI = 33.67%).
Conclusions: The present meta-analysis provides clinically relevant information regarding
the shape, location, and height variations of the ML. Understanding such variations of the ML
is crucial when performing malocclusion corrections procedures that require the ML as a
landmark, namely sagittal split ramus osteotomy, and intraoral vertical ramus osteotomy.
Furthermore, effective anesthetic blocks during oral and maxillofacial procedures can be
accomplished with a higher success rate if the correct site of injection is identified. The
possible locations of the ML should be considered in order to determine the location of the
mandibular foramen and, therefore, inferior alveolar bundle in order to prevent motor,
sensory, or perfusion pathology during maxillofacial and oral procedures of the lower jaw.
... Variations in the morphological types of the lingula among different populations and races have been reported [5,6,[8][9][10][11][12][13][14][15][16] (Table 6). The triangular variant was more prevalent in the Indian population [6,13] and truncated variant was common in Thai [5], South African [11], Brazilian [10] and Italian [16] population groups. ...
... Variations in the morphological types of the lingula among different populations and races have been reported [5,6,[8][9][10][11][12][13][14][15][16] (Table 6). The triangular variant was more prevalent in the Indian population [6,13] and truncated variant was common in Thai [5], South African [11], Brazilian [10] and Italian [16] population groups. The present study revealed that the nodular shape of the lingula was most frequently found (37.6%) which corroborates with the findings of other studies in Turkish [8,9] and Korean populations [12]. ...
Adequate knowledge of the anatomy of the medial aspect of the mandibular ramus is essential in order to prevent inferior alveolar nerve anesthetic failure and nerve injuries associated with mandibular ramal surgical procedures. The purpose of this study was to assess the morphology of the lingula and analyze the correlation of presence probability between the lingula and antilingula using cone-beam computed tomography (CBCT). Three-dimensional images reconstructed from mandibular CBCT images of 125 Saudi individuals (250 sides), aged 16–36 years, were retrospectively evaluated for distribution in the shape of the lingulae. Additionally, the presence probability of the lingula and antilingula was assessed with respect to gender and the mandible (unilateral and bilateral), and correlation between the variables was analyzed. A nodular shape of the lingula was most commonly found (37.6%) followed by a triangular shape (30%). No significant differences were observed between the genders with regard to the presence of the lingula (p = 0.108) and antilingula (p = 0.530). Gender was non-significantly correlated with the presence of the lingula and antilingula, whilst the presence of lingula showed a significant but weak correlation with that of the antilingula (rs = 0.221; p = 0.000). The present study provides information regarding morphological variations of the mandibular lingula in the Saudi population. The presence of the lingula was unassociated with that of the antilingula and hence consideration of the antilingula as the absolute landmark for mandibular ramus surgical procedures seems insufficient.
... The Li constitutes the medial boundary of the MF and thereby has a connection with the inferior alveolar nerve and accompanying vascular structures. 10,11 Thus, Li is considered as an important anatomical reference when performing certain procedures like sagittal split/ vertical ramus or inverted-L osteotomies, management of trauma and benign/malignant lesions, pre-prosthetic surgeries, and surgeries of the temporomandibular joint. 4,10-12 Furthermore, precise determination of MF is crucial for the management of inferior alveolar nerve (IAN) neuralgia, and IAN block, which is a fundamental procedure for most dental procedures in the mandible. ...
Objective: The purpose of this study was to provide morphometric and anatomical data for mandibular lingula (Li) in The Turkish population using three dimensional-cone beam computed tomography (3D-CBCT) images. Methods: CBCT images of the patients taken between July 2020 and March 2021, were retrieved from the archival records. A total of 100 Li’s of 50 patients who met the criteria of this study were evaluated. The distances between the tip of the Li and ramal landmarks/occlusal plane were measured and the shape of the Li was evaluated on 3D-CBCT images. Results: CBCT images of the 50 patients (19 males and 31 females) with an age range of 18 to 56 years were included in this study. Significant differences were found for the measurements of right LP (p < 0.001), left LP (p = 0.003), right LOP (p = 0.016) and left LOP (p = 0.007) between genders. A significant difference was observed for LI (p = 0.024) between the left and right sides. Regarding the shape of the Li significant difference was found between the right and left sides (p = 0.003), while no significant differences were observed among genders on either both sides. Conclusion: This study contributes additional data to the literature about the location and morphology of the Li in Turkish subpopulation. These results provide a reference for the clinicians regarding the procedures involving mandibular ramus to perform maneuvers in safe margins.
... Variation in height of lingula in adult mandible among East Indian ethnic origin has been described by Nicholsan et al. 6 Alves et al. have also noted that the lingula occupies more anterior portion of mandible in American Indian males. 7 Such studies pertaining to South Indian population are limited. Hence, this study aims to ascertain the distance of lingula from its anterior, posterior, and inferior border of mandible and course of inferior alveolar nerve through simulating SSRO in the dry human mandible belonging to the South Indian population. ...
... Tuli et al. [4], through visual inspection, divided 65 dry mandible lingula into four types, namely the triangular, truncated, nodular, and the assimilated types, which have prevalence rates of 68.5%, 15.8%, 10.9%, and 4.8%, respectively. Subsequent studies [6][7][8] have mostly classified mandible lingula according to Tuli's method. In the dry mandible group, the prevalence of lingula types varied greatly, as reported in previous articles [14][15][16][17]. ...
... Investigating the bilateral symmetry, the triangular type was the most common in the dry mandible group, whereas the nodular type was the most common in the CBCT group. Alves et al. [8] reported no significant differences in lingula types on the left and right sides of the mandible. ...
... Asdullah et al. [9] (dry mandible group) observed no significant differences in lingula types between men and women. However, Alves et al. [8] (dry mandible group) found significant differences in lingual types between men and women: the truncated type was significantly more common among women than men, whereas the triangular type was significantly more common among men than women. Senel et al. [11] (CBCT group) and Jung et al. [12] (CBCT group), who conducted studies on Turkish and Korean populations, observed no significant differences in the lingula types between men and women. ...
Purpose:
The purpose of the study was to review the literature on the shape of the mandibular lingula.
Methods:
English articles published from 1970 to 2021 in databases (PubMed, Web of Science, and Embase) were selected. Articles meeting the search strategy were evaluated based on the eligibility criteria (participants aged 18 years and over). Dry mandibles and cone beam computed tomography (CBCT) images were used as research materials. The shapes of mandibular lingula were classified as triangular, truncated, nodular, and assimilated.
Results:
Based on the eligibility criteria, 10 articles (six with dry mandibles and four with CBCT images) were selected for full-text reading and detailed examination. In the dry mandible group, triangular, truncated, nodular, and assimilated lingula were observed on 446, 398, 232, and 69 sides, respectively. In the CBCT group, nodular, truncated, triangular, and assimilated lingula were observed on 892, 517, 267, and 88 sides, respectively. Therefore, the most common lingula types in the dry mandible and CBCT groups were different. The assimilated type was the least common in both groups.
Conclusion:
In the dry mandible group, the most common lingula type was triangular, followed by truncated, nodular, and assimilated types. In the CBCT group, the most common lingula type was nodular, followed by truncated, triangular, and assimilated types. There were no significant differences in lingula types between the left and right sides of the mandible.
... Factors that may cause confusion must also be controlled, for example: not carrying out the analysis based on age ranges, since young individuals (less than 18 years) do not present clearly marked sexual differentiation; or not adapting the analysis to the type of population, when more than one population or ethnic group may be involved. In a previous study by our team, we showed metric differences between black-and white-skinned individuals; therefore the ethnic factor must also be considered, as it may affect measurements (Alves & Deana, 2015). Another factor to consider is the method used to take the measurements, for example whether the dry mandible was stabilised to ensure that it remained in the same position throughout. ...
Sex estimation is the first step in human identification. The mandibular ramus and the condyle have been widely used as indicators for sexual diagnosis because they are regions that undergo important morphological changes which increase sexual dimorphism. The object of the present study was to carry out a systematic review to determine the metric parameters of the mandibular ramus that present the greatest sexual dimorphism, and to sex estimation from the angle of mandible (MA). We included documents in English, Spanish and Portuguese which analysed sex estimation or sex diagnosis by metric analysis of the mandibular ramus in humans. The search was conducted in PubMed/MEDLINE, EMBASE, LILACS, up to December 2020. The risks of bias were analysed using the AQUA tool. The search identified 538 studies. After exclusion of duplicates and irrelevant articles, 39 studies were included for qualitative analysis. Of these, 18 studies were carried out on dry mandibles and 21 by imaging techniques, totalling 7270 participants of 14 different nationalities. We found 14 sex-estimation parameters in the mandibular ramus, plus the MA. Sex estimation by the MA is variable; it is a good predictor only for some populations. The height of the mandibular ramus, the angle of mandible, the bicondylar angle and the height of the coronoid process were the estimation parameters cited in the greatest number of studies. The mandibular ramus presents great sexual dimorphism and can be used as a sex predictor in different populations. Although some parameters of the mandibular ramus can present accuracy of almost 80 % when analysed in isolation, more accurate sex estimation is achieved when the parameters are analysed in conjunction.
... Several studies investigated the anatomy and the location of the Li using dry skulls [4,[13][14][15], panoramic radiographs [5,16,17], or conventional computed tomography (CT) [18]. Panoramic radiography provides different magnifications of the maxilla and the mandible, causing difficulties in visualizing mandibular landmarks [19]; moreover, panoramic radiography involves an inevitable distortion linked to the positioning of the investigated structures on different planes [20,21]. ...
... ± 4.35 mm. Similar values were found in Kun-Jung's studies, with mean values of 31.20 ± 3.81 mm [3]; lower values in the study by ArunKumar et al. [36], with a mean VDLiMB of 14.10 ± 2.5 mm; and higher values emerged in the study by Alves et al. [14]. ...
Background:
the position of the mandibular lingula (Li) affects the success rate of the inferior alveolar nerve block (IANB) and ramus osteotomies. This study evaluated the position of the Li, to investigate the anatomical relationship between the Li and some anatomical measurements using cone beam computed tomography (CBCT).
Methods:
201 hemimandibular CBCTs of 111 patients (43 males and 68 females; 18 to 88 years old) were retrospectively evaluated. The Li location was determined from the lingula tip to: the occlusal plane, the anterior and posterior borders of the mandibular ramus, the lower border of the mandible, the distal surface of the mandibular second molar, and the mandibular notch. We evaluated the correlations between the Li and the anteroposterior diameter of the mandibular ramus; the vertical distance between condyle and mandibular angle; the mesial-distal diameter of the first, second, and third mandibular molar, the intercanine distance, the intermolar distances among the first, second, and third mandibular molars; the distance between the intermolar line of the first molar and midline, and the length of the mandibular body.
Results:
the vertical distance of the Li from the occlusal plane was 11.22 ± 4.27 mm. Some parameters significantly correlated with the anatomical measurements taken into consideration.
Conclusions:
the present study provides new information concerning the Li and mandibular anatomy in the Italian population. Moreover, by correlating some anatomic measurements to the Li position, the localization of the Li is made possible, indirectly through the measurement of some distances between anatomical landmarks.
... He has also concluded that, sex disparity in the shape of lingula is more remarkable when compared to the race dimporphism. 14 Future scope of the study is to analyse the varying shape and prevalence of lingula in live patient by radiological methods using cone beam computerised tomography and orthopandamogram. ...
