European Radiology

, Volume 25, Issue 4, pp 1148–1153 | Cite as

Radiological assessment of the inferior alveolar artery course in human corpse mandibles

  • Kristina BertlEmail author
  • Lena Hirtler
  • Toni Dobsak
  • Patrick Heimel
  • André Gahleitner
  • Christian Ulm
  • Hanns PlenkJr.
Head and Neck



CT assessment of the entire course of the inferior alveolar artery (IAA) within the mandibular canal.


After contrast medium injection (180 or 400 mg/ml iodine concentration) into the external carotid arteries of 15 fresh human cadaver heads, the main IAA’s position in the canal (cranial, buccal, lingual or caudal) was assessed in dental CT images of partially edentulous mandibles.


The course of the main IAA could be followed at both iodine concentrations. The higher concentration gave the expected better contrast, without creating artefacts, and improved visibility of smaller arteries, such as anastomotic sections, dental branches and the incisive branch. The main IAA changed its position in the canal more often than so far known (mean 4.3 times, SD 1.24, range 2–7), but with a similar bilateral course. A cranial position was most often detected (42 %), followed by lingual (36 %), caudal (16 %) and buccal ( 6 %).


With this non-invasive radiologic method, the entire course of the main IAA in the mandibular canal could be followed simultaneously with other bone structures on both sides of human cadaver mandibles. This methodology allows one to amend existing anatomical and histological data, which are important for surgical interventions near the mandibular canal.

Key points

Contrast medium injection displayed the inferior alveolar artery’s course on mandibular CTs

An iodine concentration of 400 mg/ml enabled visibility until the chin

Frequent position changes of the artery in the mandibular canal were detected

Cranial and lingual positions were most often determined

Course similarities on the respective left and right sides were found


CT angiography Computed tomography Inferior alveolar artery Mandibular canal Cadaver study 



The authors of this study express special appreciation and thankfulness to the senior author Prof. Hanns Plenk Jr., who significantly contributed to this project, but unexpectedly passed away in June 2014. Further, the authors thank Teresa Keindl and Helge Schöchtner for their support in performing the CT scans. All authors have read and approved the manuscript and have agreed with submission to this journal.

The scientific guarantor of this publication is Prof. Christian Ulm, DMD, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Stefan Lettner (Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral Surgery, Medical University of Vienna, Austria) kindly provided statistical advice in drawing Fig. 3. Institutional review board approval was obtained. Written informed consent was not required for this study because the human corpses used for contrast medium injection and the CT imaging protocol had been bequeathed to the Anatomical Institute of the Medical University of Vienna for medical–scientific research and training purposes. Methodology: diagnostic and experimental study.

Supplementary material

Movie 1

An example of the course of both inferior alveolar arteries (IAAs; red) in the mandibular canal, with 2 exiting dental branches on the right side and 3 exiting dental branches on the left side. The movie is rebuilt from the same specimen as Figure 1. (MPG 95685 kb)


  1. 1.
    Fawcett E (1895) The structure of the inferior maxilla, with special reference to the position of the inferior dental canal. J Anat Physiol 29:355–366PubMedCentralPubMedGoogle Scholar
  2. 2.
    Hillerup S (2008) Iatrogenic injury to the inferior alveolar nerve: etiology, signs and symptoms, and observations on recovery. Int J Oral Maxillofac Surg 37:704–709CrossRefPubMedGoogle Scholar
  3. 3.
    Correa LR, Spin-Neto R, Stavropoulos A, Schropp L, da Silveira HE, Wenzel A (2014) Planning of dental implant size with digital panoramic radiographs, CBCT-generated panoramic images, and CBCT cross-sectional images. Clin Oral Implants Res 25:690–695CrossRefPubMedGoogle Scholar
  4. 4.
    Kaeppler G (2010) Applications of cone beam computed tomography in dental and oral medicine. Int J Comput Dent 13:203–219PubMedGoogle Scholar
  5. 5.
    Schropp L, Stavropoulos A, Gotfredsen E, Wenzel A (2011) Comparison of panoramic and conventional cross-sectional tomography for preoperative selection of implant size. Clin Oral Implants Res 22:424–429CrossRefPubMedGoogle Scholar
  6. 6.
    Kaeppler G (2000) Conventional cross-sectional tomographic evaluation of mandibular third molars. Quintessence Int 31:49–56PubMedGoogle Scholar
  7. 7.
    Kim ST, Hu KS, Song WC, Kang MK, Park HD, Kim HJ (2009) Location of the mandibular canal and the topography of its neurovascular structures. J Craniofac Surg 20:936–939CrossRefPubMedGoogle Scholar
  8. 8.
    Pogrel MA, Dorfman D, Fallah H (2009) The anatomic structure of the inferior alveolar neurovascular bundle in the third molar region. J Oral Maxillofac Surg 67:2452–2454CrossRefPubMedGoogle Scholar
  9. 9.
    Flanagan D (2003) Important arterial supply of the mandible, control of an arterial hemorrhage, and report of a hemorrhagic incident. J Oral Implantol 29:165–173CrossRefPubMedGoogle Scholar
  10. 10.
    Bertl K, Heimel P, Reich KM, Schwarze UY, Ulm C (2014) A histomorphometric analysis of the nature of the mandibular canal in the anterior molar region. Clin Oral Investig 18:41–47CrossRefPubMedGoogle Scholar
  11. 11.
    Nasel C, Gahleitner A, Breitenseher M et al (1998) Localization of the mandibular neurovascular bundle using dental magnetic resonance imaging. Dentomaxillofac Radiol 27:305–307CrossRefPubMedGoogle Scholar
  12. 12.
    Nasel CJ, Pretterklieber M, Gahleitner A, Czerny C, Breitenseher M, Imhof H (1999) Osteometry of the mandible performed using dental MR imaging. AJNR Am J Neuroradiol 20:1221–1227PubMedGoogle Scholar
  13. 13.
    Kress B, Gottschalk A, Anders L et al (2004) High-resolution dental magnetic resonance imaging of inferior alveolar nerve responses to the extraction of third molars. Eur Radiol 14:1416–1420CrossRefPubMedGoogle Scholar
  14. 14.
    Krasny A, Krasny N, Prescher A (2012) Study of inferior dental canal and its contents using high-resolution magnetic resonance imaging. Surg Radiol Anat 34:687–693CrossRefPubMedGoogle Scholar
  15. 15.
    Terumitsu M, Seo K, Matsuzawa H, Yamazaki M, Kwee IL, Nakada T (2011) Morphologic evaluation of the inferior alveolar nerve in patients with sensory disorders by high-resolution 3D volume rendering magnetic resonance neurography on a 3.0-T system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111:95–102CrossRefPubMedGoogle Scholar
  16. 16.
    Gahleitner A, Watzek G, Imhof H (2003) Dental CT: imaging technique, anatomy, and pathologic conditions of the jaws. Eur Radiol 13:366–376PubMedGoogle Scholar
  17. 17.
    Katsumi Y, Tanaka R, Hayashi T, Koga T, Takagi R, Ohshima H (2013) Variation in arterial supply to the floor of the mouth and assessment of relative hemorrhage risk in implant surgery. Clin Oral Implants Res 24:434–440CrossRefPubMedGoogle Scholar
  18. 18.
    Cappabianca S, Scuotto A, Iaselli F et al (2012) Computed tomography and magnetic resonance angiography in the evaluation of aberrant origin of the external carotid artery branches. Surg Radiol Anat 34:393–399CrossRefPubMedGoogle Scholar
  19. 19.
    Pogrel MA, Dodson T, Tom W (1987) Arteriographic assessment of patency of the inferior alveolar artery and its relevance to alveolar atrophy. J Oral Maxillofac Surg 45:767–770CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  • Kristina Bertl
    • 1
    • 2
    Email author
  • Lena Hirtler
    • 3
  • Toni Dobsak
    • 1
    • 4
    • 5
  • Patrick Heimel
    • 4
    • 5
    • 6
  • André Gahleitner
    • 1
    • 7
  • Christian Ulm
    • 1
  • Hanns PlenkJr.
    • 8
  1. 1.Division of Oral Surgery, Bernhard Gottlieb School of DentistryMedical University of ViennaViennaAustria
  2. 2.Department of Periodontology, Faculty of OdontologyMalmö UniversityMalmöSweden
  3. 3.Center for Anatomy and Cell Biology, Department of Systematic AnatomyMedical University of ViennaViennaAustria
  4. 4.Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Division of Oral SurgeryMedical University of ViennaViennaAustria
  5. 5.Austrian Cluster for Tissue RegenerationViennaAustria
  6. 6.Ludwig Boltzmann Institute for Clinical and Experimental TraumatologyViennaAustria
  7. 7.Department of Diagnostic Radiology, Division of Osteoradiology, General HospitalMedical University of ViennaViennaAustria
  8. 8.Bone and Biomaterials Research, Institute for Histology and EmbryologyMedical University of ViennaViennaAustria

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