The Lateral Lingual Foramen: A Structure to Consider in Planning in Implantology and Oral Surgery

For decades, dental diagnosis and treatment planning were based on 2-dimensional imaging techniques, which had respective limitations.¹ Currently, cone bean tomography can provide detailed information about maxillofacial structures and describe anatomical variations with greater precision.^2–4

Nowadays, 3-dimensional presurgical planning in oral surgery and implantology are essential to achieve optimal esthetic and functional results in inpatient treatments. Another benefit of adequate and precise digital planning is the reduction of transoperative and postoperative complications derived from injuries to existing anatomical structures in the area to be operated on.²

Complications related to mandibular anatomical structures, such as the mental foramen and the lower dental canal, are relatively easy to predict. However, some structures, such as the lingual and lateral lingual foramen, are less common yet must be considered when treatment planning.² Placing dental implants in the anterior mandible is a relatively safe and common procedure. The incidence of surgical complications in this area is relatively low.⁵ Although lateral lingual foramen are not so frequent, there are reports of a percentage of presentation of the lateral lingual foramen of 38%.⁶

Lingual lateral foramen presents as emergencies of the lower dental canal that opens toward the lingual cortex behind the canine, giving way to a neurovascular bundle susceptible to injury during procedures in which it is necessary to elevate flaps and make osteotomies of the lingual cortex (removal of the mandibular torus and retained teeth) as well as other preprosthetic surgery procedures and for preparation of alveolar processes that will receive dental implants.²

In a review of 25 mandibular volumetric tomography scans, we incidentally found a case of a lateral lingual foramen located between teeth 45 and 46, oval in shape, measuring 2 × 4 mm, and at a distance from the basal edge of 9 mm, which, if injured, could cause complications (Figure).

This is why emphasis should be placed on the development of adequate and complete tomographic planning, always considering these nonconstant anatomical structures, even in routine surgeries, such as the removal of lingual torus or impacted teeth, to reduce the risk of complications, such as hemorrhages and paresthesias.

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