Assessment of Mandibular Foramen Position for Inferior Alveolar Nerve Block in Children

Abstract

Introduction: In children the administration of inferior alveolar nerve block at the target site varies and repeated injection may result in a negative behavior and also increase the risk of overdose. This study correlates the relative position of the mandibular foramen with occlusal plane as a clinical guide for inferior alveolar nerve block in children from 3-13 years.

Methods: A cross-sectional study was conducted on 180 orthopantamographs of children from June 2021 to January 2022. The radiographs were digitally traced, analyzed to obtain linear and angular measurements of mandibular foramen to occlusal plane, anterior, posterior and lower border of mandible along with gonial angle. Paired t-test, unpaired t-test was used along with Karl Pearson’s test for correlation.

Results: The results suggested that the needle for inferior alveolar nerve block should be placed below the occlusal plane in 3–4 year (L-1.38, R-1.36 mm approximately), above the level of occlusal plane in 5–7 years (L-2.59, R-2.77 mm), 7–9 years (L-3.71, R-3.86 mm), 9–12 years (L-3.5, R-4.14 mm), 11–12 years (L-3.97, R-4.35 mm), and 12–13 years (L-4.24, R-4.7 mm) old children respectively. The distance of the mandibular foramen from anterior border of mandible was greater than that from posterior border and the gonial angle values decreased with subsequent stages. However, there was statistically significant mean difference in mandibular foramen from anterior border of ramus as well as occlusal plane between right and left sides.

Conclusions: There was vertical and horizontal alteration in the position of the bony landmarks within the jaws and it is necessary to modify the placement of needle during inferior alveolar nerve block with advancing age due to skeletal growth and also between right and left sides. The decrease in gonial angle indicated increased growth potential of the mandible with age.