open access
메뉴
open access
메뉴
ISSN : 0376-4672
하악관은 하악공에서 이부로 하치조 신경혈관다발이 주행하는 구조물로 일반적으로 단일구조물로 알려져 있으나 이열 혹은 삼열하악관 등 부하악관이 꾸준히 보고되어 왔다. 부하악관은 하악 제3대구치 발치, 이식 골 채취, 시상골절단술 등 하악골을 포함하는 외과적 술식과 관련하여 과다 출혈이나 감각이상 등의 합병증을 야기할 수 있으며 하치조 신경마취에 어려움을 줄 수 있으므로 존재여부와 경로에 대한 정보를 파악하여야 한다. 과거 파노라마 방사선사진을 이용한 연구에서는 이열하악관의 발생빈도가 1% 미만으로 보고되었으나 최근 콘빔 CT를 이용한 연구에서는 환자의 0.2~65%에서 이열 혹은 삼열하악관이 관찰된다는 연구결과가 보고되어 부하악관이 상당히 흔히 나타나는 해부학적 변이임을 말해준다. 콘빔 CT는 고해상도의 3차원 및 2차원 다면상이 가능하고 이미지 뷰어상에서 판독자가 원하는 단면상을 실시간으로 재구성할 수 있으므로 하악관의 분지를 쉽게 인식할 수 있다. 대부분의 부하악관은 하악 제3대구치 후방에서 분지되며 한국인의 평균 길이가14.97㎜로 보고 된 바와 같이 주로 제3대구치부에서 끝나므로 제3대구치의 발치나 이식골 채취 등 제3대구치 포함된 술식을 시행할 때 특히 주의가 필요하다. 본 연구의 목적은 콘빔 CT를 이용하여 한국인에 있어서 하악 제3대구치부에서의 부하악관의 발생빈도와 특성을 파악하고자 함에 있다.
Purpose: This study was performed to examine distribution of accessory mandibular canal and its characteristics in mandibular third molars. Materials and methods: A total of 251 subjects (166 males and 85 females) having mandibular third molars bilaterally were included in the study. Cone-beam computed tomographic images were reviewed for bifid or trifid accessory mandibular canal. The prevalence of accessory mandibular canal was evaluated according to gender, side and its branching type. Proximity and crosssectional position of accessory mandibular canal to mandibular third molar was analyzed. Results: Accessory mandibular canals were found in 66 (26.3%) of 251 patients and 86 (17.1%) of 502 hemi-mandibles. Gender and sides showed no statistically significant differences in prevalence. Retromolar canal (46.1%) was the most common branching type. Proximity of accessory canal to mandibular third molars showed mean distance of 2.8 mm from third molar and a statistically significant difference was found among types of accessory canal. Dental canal was the closest to tooth among branching types and closer to tooth than main canal. On cross-sectional view, accessory canal was generally located on buccal side of mandibular third molar. Conclusion: Accessory mandibular canal was common and well detected with cone-beam computed tomography. Their localization is significant in all anesthetic and surgical procedures involving mandibular third molars.
1. Rashsuren O, Choi JW, Han WJ, Kim EK. Assessment of bifid and trifid mandibular canals using cone-beam computed tomography. Imaging Sci Dent. 2014;44(3):229-36.
2. Kang JH, Lee KS, Oh MG, Choi HY, Lee SR, Oh SH, Choi YJ, Kim GT, Choi YS, Hwang EH. The incidence and configuration of the bifid mandibular canal in Koreans by using cone-beam computed tomography. Imaging Sci Dent. 2014;44(1):53-60.
3. Kuczynski A, Kucharski W, Franco A, Westphalen FH, de Lima AA, Fernandes A. Prevalence of bifid mandibular canals in panoramic radiographs: a maxillofacial surgical scope. Surg Radiol Anat. 2014;36(9):847-50.
4. Lizio G, Pelliccioni GA, Ghigi G, Fanelli A, Marchetti C. Radiographic assessment of the mandibular retromolar canal using cone-beam computed tomography. Acta Odontol Scand. 2013;71(3-4):650-5.
5. Earl Fu, Michelle Peng, Cheng-Yang Chiang, Hsiao-Pei Tu, Yaoh-Shiang Lin, E-Chin Shen. Bifid mandibular canals and the factors associated with their presence: a medical computed tomography evaluation in a Taiwanese population. Clin. Oral Impl. Res. 2014;25(2):e64-7.
6. Kuribayashi A, Watanabe H, Imaizumi A, Tantanapornkul W, Katakami K, Kurabayashi T. Bifid mandibular canals: cone beam computed tomography evaluation. Dentomaxillofac Radiol. 2010;39(4):235-9.
7. Naitoh M, Nakahara K, Suenaga Y, Gotoh K, Kondo S, Ariji E. Comparison between cone-beam and multislice computed tomography depicting mandibular neurovascular canal structures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(1):e25-31.
8. Naitoh M, Hiraiwa Y, Aimiya H, Ariji E. Observation of bifid mandibular canal using cone-beam computerized tomography. Int J Oral Maxillofac Implants. 2009;24(1):155-9.
9. 이현우, 김여갑, 이백수,권용대, 최병준,김영란. 이열하악관(Bifid mandibular canal): 방사선 소견과임상적 의의 -증례보고- 대한치과마취과학회지. 2009;9(1):24-9.
10. Kaufman E, Serman NJ, Wang PD. Bilateral mandibular accessory foramina and canals: a case report and review of the literature. Dentomaxillofac Radiol. 2000;29(3):170-5.
11. Bilecenoglu B, Tuncer N. Clinical and anatomical study of retromolar foramen and canal. J Oral Maxillofac Surg. 2006;64(10):1493-1497.
12. Grover PS, Lorton L. Bifid mandibular nerve as a possible cause of inadequate anesthesia in the mandible. J Oral Maxillofac Surg. 1983;41(3):177-9.
13. Nortjé CJ, Farman AG, Grotepass FW. Variations in the normal anatomy of the inferior dental (mandibular)canal: a retrospective study of panoramic radiographs from 3612 routine dental patients. Br J Oral Surg. 1977;15:55-63.
14. Langlais RP, Broadus R, Glass BJ. Bifid mandibular canals in panoramic radiographs. J Am Dent Assoc. 1985;110(6):923-6.
15. Patil S, Matsuda Y, Nakajima K, Araki K, Okano T. Retromolar canals as observed on cone-beam computed tomography: their incidence, course, and characteristics. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(5):692-9.
16. de Oliveira-Santos C, Souza PH, de Azambuja Berti-Couto S, Stinkens L, Moyaert K, Rubira-Bullen IR, Jacobs R. Assessment of variations of the mandibular canal through cone beam computed tomography. Clin Oral Investig. 2012;16(2):387-93.
17. Orhan K, Aksoy S, Bilecenoglu B, Sakul BU, Paksoy CS. Evaluation of bifid mandibular canals with cone-beam computed tomography in a Turkish adult population a retrospective study. Surg Radiol Anat. 2011;33(6):501-7.
18. von Arx T, Hänni A, Sendi P, Buser D, Bornstein MM. Radiographic Study of the Mandibular Retromolar Canal An Anatomic Structure with Clinical Importance. J Endod. 2011;37(12):1630-5.