Clinical anatomy of the accessory mandibular foramen: application to mandibular ramus osteotomy

  • Joe IwanagaEmail author
  • Shogo Kikuta
  • Soichiro Ibaragi
  • Koichi Watanabe
  • Jingo Kusukawa
  • R. Shane Tubbs
Original Article



An accessory foramen around the mandibular foramen is called an accessory mandibular foramen (AMF). The clinical anatomy of the AMF has not been well described. The aim of this study was to reveal the clinical anatomy of the AMF for a better understanding of its implication during ramus surgeries.


Twenty-two sides fresh-frozen cadaveric heads with a mean age of 76.2 ± 14.4 years at death underwent dissection. The neurovascular bundles passing through the AMF were observed. Additionally, a hemi-face of a latex injected embalmed cadaver was dissected medially to laterally and the neurovascular bundles of the AMF investigated.


A unilateral foramen, bilateral foramina, and absence of foramina were found in 45.4%, 18.2%, and 36.4%, respectively. The origin of the neurovascular bundle entering the AMF was a branch of the maxillary artery in 20% and a tributary of the inferior alveolar vein in 80%. In the latex embalmed cadaver, the AMF was found to contain a branch from the maxillary artery and a tributary of the maxillary vein.


Given the practical meaning of the specific AMF located in the operative field of the ramus osteotomy, we suggest these be named “foramina for ramus osteotomy.”


Mandibular foramen Mandibular canal Inferior alveolar nerve Maxillary artery Orthognathic surgery Hemorrhage 



The authors would like to thank who donated their body for the advancement of medical education and research. All the authors have read the manuscript and have approved this submission.

Author contributions

JI: Protocol/project development, Data collection, Data analysis, Manuscript writing. SK: Data collection, Manuscript writing. SI: Data analysis, Manuscript writing. KW: Data analysis, Manuscript editing. JK: Protocol/project development, Data analysis, Manuscript editing. RST: Protocol/project development, Data collection, Manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors received no funding or grants for this work from any organization or foundation. The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Seattle Science FoundationSeattleUSA
  2. 2.Dental and Oral Medical CenterKurume University School of MedicineKurumeJapan
  3. 3.Division of Gross and Clinical Anatomy, Department of AnatomyKurume University School of MedicineKurumeJapan
  4. 4.Department of Oral and Maxillofacial SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  5. 5.Department of Anatomical SciencesSt. George’s UniversitySt. George’sGrenada

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