Location of the Mandibular Lingula in Pediatric Patients using CBCT Images

Abstract

Purpose: To determine the position of the mandibular lingula in a sample of CBCTs taken on pediatric patients, with a focus on implications for administration of local anesthesia. Methods: A sample of 280 outpatient CBCT (i-CAT) scans (153 males and 127 females) (UW-SoD dept. of pediatric dentistry) were divided into age groups: 6-9 year olds (N=103), 10-13 year olds (N=103), and 14-18 year olds (N=74). An ANOVA test was used to compare across age groups, with significance level set to P<.05. A calibrated investigator assessed all images using InVivo5 (Anatomage) software. The position of the lingula was determined relative to the anterior and posterior border of the ramus, the mandibular notch, the inferior border of the mandible and the mandibular plane. The mandibular angle was also recorded. Results: The average distance for all positional measurements was significantly greater in 14-18 year-olds when compared with 6-9 year-olds. In the oldest age group, the mandibular angle was significantly more acute. Significant differences in distances were noted bilaterally across all age groups in boys (1) and girls (2) for distance from lingula to: (1) posterior border of ramus, (1,2) mandibular notch, (1,2) inferior border mandible and (1,2) occlusal plane. Conclusions: The average distance from the mandibular lingula to anatomic markers increases with patient age. On average, the needle for inferior alveolar nerve blocks should be directed 3mm above the occlusal plane in 6-9 year-olds, 5mm above the occlusal plane in 10-13 year-olds, and 7mm above the occlusal plane in 14-18 year olds.