Lingual Perimandibular Vessels Associated with Life Threatening Bleeding –Anatomical Study

Objectives: Life threatening hemorrhage following implant insertion is not commonly reported. Most cases occurred in the interforaminal area. The main vessels injured following lingual bone perforation are the sublingual artery or the perforating submental artery. The aim of the present study was to characterize the anatomy of the lingual perimandibular vessels with special focus on the distance of the vessels to the bone. Methods: The study group comprised of 12 human cadavers (6 male and 6 female). The specimens studied were the hemi facial lower third, which were dissected by 3 sharp saggital incisions, at the canine area, mental foramen and second molar area. The incisions divided each area as an "open book" exploring the perimandibular blood vessels at the floor of the mouth. Results: The diameter of the dissected vessels ranged from 0.5-3 mm (mean: 1.5 mm). In the canine area most vessels were found above the mylohyoid muscle, and in the mental and 2nd molar areas most vessels were located beneath the muscle. The median vertical distance was the smallest in the canine area (14.5 mm compare with 15.5 in the mental area and 19 mm in the 2nd molar area). The median horizontal distance of the vessels from the lingual plate was 2 mm in the canine and 2nd molar and 4mm in the mental area. Conclusions: Perforation of the lingual plate especially anterior to the canine area can easily injury the blood vessels at the floor of mouth. Avoiding such hazardous complication requires a highly skilled surgeon with extensive knowledge in interpreting radiographs, in the operative procedure and trained in management of acute airway obstruction and other medial emergencies.