The Lateral Lingual Foramen of the Mandible: Its Impact on Implant Surgery

The lateral lingual foramen, a small but significant anatomical structure in the mandible, has profound implications for dental implant surgery. In many ways it is very similar to the canalis sinuosus in the maxilla.

Where is the lateral lingual foramen?

This foramen is located on the inner surface of the mandible, typically near the premolar region. It provides a passageway for neurovascular structures, including branches of the sublingual artery and veins. While often overlooked, its presence is critical to consider during surgical planning to avoid complications.

How common is it to have a lateral lingual foramen?

That is hard to say. The main issue is what we classify as a lingual foramen. Some may call them nutrient canals and not classify them as a lateral lingual foramen. Size and location may determine what one calls a canal or a foramen but they are the same thing really. Furthermore, as you get more detail in the imaging, smaller and smaller foramen can be seen. Wei JPD 2020 finds 70% of patients have a lateral lingual foramen. While Krishnan JOE 2018 finds it only 20% of the time.

Why does the foramen matter?

During implant surgery in the anterior mandible, unintentional damage to the lateral lingual foramen can result in significant bleeding due to its vascular connections. The sublingual artery, which traverses this foramen, has a close association with the floor of the mouth. Any vascular injury here can lead to life-threatening complications. These include a hematoma formation, airway obstruction, or severe bleeding that is difficult to control intraoperatively.

Moreover, the proximity of the foramen to cortical bone and adjacent soft tissues increases the risk of surgical challenges. If overlooked, improper implant placement could compress the neurovascular bundle, leading to postoperative discomfort or paresthesia for the patient.

How can we avoid damaging the nerve and artery in the area?

Knowing that it exists and looking for it is going to be the key to avoiding complications involving the neurovascular bundle it contains. Cone Beam Computed Tomography (CBCT) will offer a clear view of the foramen’s location, size, and its relation to the area you wish to place your dental implant. Identifying these features enables precise surgical planning, ensuring the optimal position and depth for implant placement.

Surgeons should also be aware of anatomical variations in the foramen’s size and position, which can differ among individuals. This understanding allows for customization of surgical techniques to minimize complications.

Basically get a CBCT and avoid any lateral lingual foramen when you see it!

In summary, the lateral lingual foramen’s presence underscores the importance of detailed anatomical assessment in implant surgery. Careful planning, advanced imaging, and surgical precision are key to achieving safe and successful outcomes while avoiding complications in this delicate region.