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INTRODUCTION : It is the largest and strongest bone of the face; forms the lower jaw.

Consists of a central body and two rami. Parts : 1. Body : horse-shoe (U sha!ed; hori"ontal# and con$e% forwards. &. 'ami : one ram(s on each side# !rojecting (!wards from the !osterior ends of the body. DEVELOPMENT OF THE MANDIBLE : The human mandible has n P#ena&al de'el (men& : -he cartilages and bones of the mandib(lar s.eleton form from embryonic ne(ral cells that originate in the mid-and hindbrain regions of the ne(ral folds. -hese cells migrate $entrally to form the mandib(lar (and ma%illary facial !rominences# where they differentiate into bones and connecti$e tiss(es. -he first str(ct(re to de$elo! in the region of the lower jaw is the mandib(lar di$ision of the trigeminal ner$e that !recedes the ectomesenchymal condensation forming the first (mandib(lar !haryngeal arch. -he !rior !resence of the ner$e has been !ost(lated as re/(isite for ind(cing osteogenesis by the !rod(ction of ne(rotro!hic factors. -he mandible is deri$ed from ossification of an osteogenic membrane formed from ectomesenchymal condensation at 01 to 0, days of de$elo!ment this mandib(lar ectomesenchyme m(st interact initially with the e!itheli(m of the mandib(lar arch before !rimary ossification can occ(r; the res(lting intamembrano(s bone lies lateral to 2ec.el3s cartilage of the first (mandib(lar !haryngeal arch. 4 single ossification center for each half of the mandible arises in the 1th wee. !ost conce!tion (the mandible and the cla$icle are the first bones to begin to ossify in the region of the bif(rcation ne desi!n " # li"e$% ).*. Poswillo# 1+,,

of the inferior al$eolar ner$e and artery into mental and its accom!anying ne(ro$asc(lar b(ndle. 5rom the !rimary center below and aro(nd the inferior al$eolar ner$e and its incisi$e branch# ossification s!reads (!wards to form a tro(gh for the de$elo!ing teeth. -he s!read of the intramembrano(s ossification dorsally and $entrally forms the body and ram(s of the mandible. 2ec.el3s cartilage becomes s(rro(nded and in$aded by bone. 6ssification sto!s dorsally at the site that will become the mandib(lar ling(a# where 2ec.el3s cartilage contin(es into the middle ear. -he !rior !resence of the ne(ro$asc(lar b(ndle ens(res the formation of the mandib(lar foramen and canal and the mental foramen. -he first !haryngeal-arch core of 2ec.el3s cartilage almost meets its fellow of the o!!osite side $entrally. It di$erges dorsally to end in the tym!anic ca$ity of each middle ear# which is deri$ed from the first !haryngeal !o(ch# and is s(rro(nded by the forming !etro(s !ortion of the tem!oral bone. -he dorsal end of 2ec.el3s cartilage ossifies to form the basis of two of the a(ditory ossicles (ie# the malle(s and the inc(s . -he third ossicle (the sta!es is deri$ed !rimarily from the cartilage of the second !haryngeal arch ('eichert3s cartilage . 2ec.el3s cartilage lac.s the en"yme !hos!hatase fo(nd in ossifying cartilages# th(s !recl(ding its ossification; almost all of 2ec.el3s cartilage disa!!ears by the &7th wee. after conce!tion. Parts transform into the s!henomandib(lar and anterior malleolar ligaments. 4 small !art of its $entral end (from the mental foramen $entrally to the sym!hysis forms accessory endochondral ossicles that are incor!oration into the chin region of the mandible. 2ec.el3s cartilage dorsal to the mental foramen (ndergoes resor!tion on its lateral s(rface at the same time as intramembrano(s bony trabec(lae are forming immediately lateral to the resorbing cartilage. -h(s# the cartilage from the mental foramen to the ling(la is not incor!orated into ossification of the mandible.

-he initial wo$en bone formed along 2ec.el3s cartilage is soon re!laced by lamellar bone# and ty!ical ha$ersian systems are already !resent at the 8th month !ost conce!tion. -his remodeling occ(rs earlier than it occ(rs in other bones# and is tho(ght to be a res!onse to early intense s(c.ing and swallowing# which stress the mandible. 9econdary accessory cartilages a!!ears between the 1:th and 17th wee.s !ost conce!tion to form the head of the condyle# !art of the coronoid !rocess# and the mental !rot(berance. -he a!!earnce of these secondary mandib(lar cartilages is dissociated from the !rimary !haryngeal (2ec.el3s and chondrocranial cartilages. -he secondary cartilage of the coronoid !rocess de$elo!s within the tem!oralis m(scle# as its !redecessor. -he coronoid accessory cartilage becomes incor!oration into the e%!anding intramembrano(s bone of the ram(s and disa!!ear before birth. In the mental region# on either side of the sym!hysis# one or two small cartilages a!!ear and ossify in the ;th month !ost conce!tion to form a $ariable n(mber of mental ossicles in the fibro(s tiss(e of the sym!hysis. -he ossicles become incor!orated into the intramembrano(s bone when the sym!hysis menti is con$erted from a syndesmosis into a synostosis d(ring the 1st !ostnatal year. -he condylar secondary cartilage a!!ears d(ring the 1: th wee. !ost conce!tion as a cone-sha!ed str(ct(re in the ramal region. -his condylar cartilage is the !rimordi(m of the f(t(re condyle. Cartilage cells differentiate from its center# and the cartilage condylar head increases by interstitial and a!!ositional growth. By the 7 th wee.# the first e$idence of endochondral bone a!!ears in the condyle region. -he condylar cartilage ser$es as an im!ortant center of growth for the ram(s and body of the mandible. -he nat(re of this growth < as !rimary (an initial so(rce of mor!hogenesis or secondary (com!ensating for f(nctional stim(lation < is contro$ersial# b(t e%!erimental e$idence indicates the need for mechanical

stim(li for normal growth. By the middle of fetal life# m(ch of the conesha!ed cartilage is re!laced with bone# b(t its (!!er end !ersists into ad(lthood# acting as both growth and artic(lar cartilage. Changes in mandib(lar !osition and form are related to the direction and amo(nt of condylar growth rate increases at !(berty# !ea.s between 1& = and >7 years of age# and normally ceases at abo(t &: years of age. ?owe$er# the contin(ing !resence of the cartilage !ro$ides a !otential for contin(ed growth# which is reali"ed in conditions of abnormal growth s(ch as acromegaly. P s&na&al de'el (men& : -he sha!e and si"e of the dimin(ti$e fetal mandible (ndergo considerable transformation d(ring its growth and de$elo!ment. -he ascending ram(s of the neonatal mandible is low and wide# the coronoid !rocess is relati$ely large and !rojects well abo$e the condyle# the body is merely an o!en shell containing the b(ds and !artial crowns of the decid(o(s teeth# and the mandib(lar canal r(ns low in the body. -he initial se!aration of the right and left bodies of the mandible at the midline sym!hysis menti is grad(ally eliminated between the 7th and 1&th months after birth# when ossification con$erts the syndesmosis into a synostosis# (niting the two hal$es. 4ltho(gh the mandible a!!ears as a single bone in the ad(lt# it is de$elo!mentally and f(nctionally di$isible into se$eral s.eletal s(b(nits. -he basal bone of the body forms one (nit# to which are attached the al$eolar# coronoid# ang(lar# and condylar !rocesses and the chin. -he growth !attern of each of these s.eletal s(b(nits is infl(enced by a f(nctional matri% that acts (!on the bone: the teeth act as a f(nctional matri% for the al$eolar (nit; the action of the tem!oralis m(scle infl(ences the coronoid !rocess; the masseter and medial !terygoid m(scles act (!on the angle and ram(s of the mandible; and the lateral !terygoid has some

infl(ence on the condylar !rocess. -he f(nctioning of the related tong(e and !erioral m(scles and the e%!ansion of the oral and !haryngeal ca$ities !ro$ide stim(li for mandib(lar growth to reach its f(ll !otential. 6f all the facial bones# the mandible (ndergoes the most growth !ostnatally and e$idences the greatest $ariation in mor!hology. @imited growth ta.es !lace at the sym!hysis menti (ntil f(sion occ(rs. -he main sites of !ostnatal mandib(lar growth are at the condylar cartilages# the !osterior borders of the rami# and the al$eolar ridges. -hese areas of bone de!osition largely acco(nt for increases in the height# length# and width of the mandible. ?owe$er# s(!erim!osed (!on this basic incremental growth are n(mero(s regional remodeling changes that are s(bjected to the local f(nctional infl(ences in$ol$ing selecti$e resor!tion and dis!lacement of indi$id(al mandib(lar elements. -he condylar cartilage of the mandible (ni/(ely ser$es as both (1 an artic(lar cartilage in the tem!oromandib(lar joint# characteri"ed by a fibrocartilage s(rfaced layer# and (& a growth cartilage analogo(s to the e!i!hysial !late in a long bone# characteri"ed by a dee!er hy!ertro!hying cartiliage later. -he s(barticlar a!!ositional !roliferation of cartilage within the condylar head !ro$ides the basis for the growth of a med(llary core of endochondral bone# on the o(ter s(rface of which a corte% of intramembrano(s bone is laid. -he growth cartilage may act as a Af(nctional matri%B to stretch the !erioste(m# ind(cing the lengthened !erioste(m to form intramembrano(s bone bone beneath it. -he di$erse histologic origins of the med(lla and corte% are effaced by their f(sion. -he formation of bone within the condylar heads ca(ses the mandib(lar rami to grow (!ward and bac.ward# dis!lacing the entire mandible in an o!!osite downward and forward direction. Bone resor!tion s(bjacent to the condylar head acco(nt for the narrowed condylar nec.. -he attachment of the lateral !terygoid

m(scle to this nec. and the growth and action of the tong(e and masticatory m(scles are f(nctional forces im!licated in this !hase of mandi(lar growth. 4ny damage to the condylar cartilages restricts the growth !otential and downward and forward dis!lacement of mandible# (nilaterally or bilaterally# according to the side(s damaged. @ateral de$iations of the mandible and the $arying degrees of micrognathia and accom!anying maloccl(sion res(lt. In the infant# the condyles of the mandible are inclined almost hori"ontally# so that condylar growth leads to an increase in the length of the mandible rather than to an increase in height. )(e to the !osterior di$ergence of the two hal$es of the body of the mandible (in a $ sha!e # growths in the condylar heads of the increasingly more widely dis!laced rami res(lts in o$erall widening of the mandib(lar body# which .ee!s !ace by (remodeling with the widening cranial base. Co interstitial widening of the mandible can ta.e !lace at the f(sed sym!hysis menti after the first year# a!art from some widening by s(rface a!!osition. Bone de!osition occ(rs on the !osterior border of the ram(s# whereas concomitant resor!tion on the anterior border maintains the !ro!ortions of the ram(s and# in effect# mo$es it bac.ward in relation to the body of the mandible.-his de!osition and concomitant resor!tion e%tends (! to the coronoid !rocess# in$ol$ing the mandib(lar notch# and !rogressi$ely re!ositions the mandib(lar foramen !osteriorly# acco(nting for the anterior o$erlying !late of the ling(la.-he attachment of the ele$ating m(scles of mastication to the b(ccal and ling(al as!ects of the ram(s and to the mandib(lar angle and coronoid !rocess infl(ences the (ltimate si"e and !ro!ortions of these mandib(lar elements. -he !osterior dis!lacement of the ram(s con$erts former ramal bone into the !osterior !art of the body of the mandible. In this manner# the body of the mandible lengthens# the !osterior molar region relocating interiorly

into the !remolar and canine regions. -his is one means by which additional s!ace is !ro$ided for er(!tion of the molar teeth# all three of which originate in the j(nction of the ram(s and the body of the mandible. -heir forward migration and !osterior ramal dis!lacement lengthen the molar region of the mandible. -he forward shift of the growing mandib(lar body changes the direction of the mental foramen d(ring infancy and childhood. -he mental ne(ro$asc(lar b(ndle emanates from the mandible at right angles or e$en a slightly forward direction at birth. In ad(lthood# the mental foramen (and its ne(ro$asc(lar content is characteristically directed bac.ward. -his change may be ascribed to forward growth in the body of the mandible while the ne(ro$asc(lar b(ndle Adrags alongB. 4 contrib(tory factor may be the differing growth rates of bone and !erioste(m. -he latter# by its firm attachment to the condyle and com!arati$ely loose attachment to the mandib(lar body# grows more slowly than the body# which slides forward beneath the !erioste(m. -he changing direction of the foramen has clinical im!lications in the administration of local anesthetic to the mental ner$e: in infants and children# the syringe needle may be a!!lied at right angles to the body of the mandible to enter the mental foramen whereas the needle m(st be a!!lied obli/(ely from behind to achie$e entry in the ad(lt. -he location of the mental foramen also alters its $ertical relationshi! within the body of the mandible from infancy to old age. Dhen teeth are !resent# the mental foramen is located midway between the (!!er and lower borders of the mandible. In the edent(lo(s mandible# lac.ing an al$eolar ridge# the mental foramen a!!ears near the (!!er margin of the thinned mandible. -he al$eolar !rocess de$elo!s as a !rotecti$e tro(gh in res!onse to the tooth b(ds and becomes s(!erim!osed (!on the basal bone of the mandib(lar body. It adds to the height and thic.ness of the body of the

mandible and is !artic(larly manifest as a ledge e%tending ling(ally to the ram(s to accommodate the third molars. -he al$eolar bone fails to de$elo! if teeth are absent and resorbs in res!onse to tooth e%traction. -he orthodontic mo$ement of teeth ta.es !lace in the labile al$eolar bone to both ma%illa and mandible and fails to in$ol$e the (nderlying basal bone. -he chin# formed in !art of the mental ossicles from accessory cartilages and the $entral end of 2ec.el3s cartilage# is $ery !oorly de$elo!ed in the infant. If de$elo!s almost as an inde!endent s(b(nit of the mandible# infl(enced by se%(al as well as s!ecific genetic factors. 9e% differences in the sym!hyseal region of the mandible are not significant (ntil other secondary se% characteristics de$elo!. -h(s# the chin becomes significant only at adolescence# from the de$elo!ment of the mental !rot(berance and t(bercles. Dhereas small chins are fo(nd in ad(lts of both se%es# $ery large chins are characteristically masc(line. -he s.eletal A(nitB of the chin may be an e%!ression of the f(nctional forces e%erted by the lateral !terygoid m(scles that# in !(lling the mandible forward# indirectly stress the mental sym!hyseal region by their concomitant inward !(ll. Bone b(ttressing to resist m(scle stressing# which is more !owerf(l in the male# is e%!ressed in the more !rominent male chin. -he !rotr(si$e chin is a (ni/(ely h(man trait# lac.ing in all other !rimates and in hominid ancestors. -he mental !rot(berance forms by osseo(s de!osition d(ring childhood. Its !rominence is accent(ated by bone resor!tion in the al$eolar region abo$e it# creating the s(!ramental conca$ity .nown as A!oint BB in orthodontic terminology. Underde$elo!ment of the chin is .nown as microgenia. -he tor(s mandib(laris# a genetically determined e%ostosis on the ling(al as!ect of the body of the mandible# de$elo!s ((s(ally bilaterally in the canine-!remolar region. -his tor(s is (nrelated to any m(scle attachments or .nown f(nctional matrices.

)(ring fetal life# the relati$e si"es of the ma%illa and mandible $ary widely. Initially# the mandible is considerable larger than the ma%illa# a !redominance lessened later by the relati$ely greater de$elo!ment of the ma%illa; by abo(t , wee.s !ost conce!tion# the ma%illa o$erla!s the mandible. -he s(bse/(ent relati$ely greater growth of the mandible res(lts in the a!!ro%imately e/(al si"e of the (!!er and lower jaws by the 11 th wee.. 2andib(lar growth lags behind ma%illary growth between the 10th and &:th wee.s d(e to a changeo$er from 2ec.el3s cartilage to condylar secondary cartilage as the main growth determinant of the lower jaw. 4t birth# the mandible tends to be retrognathic to the ma%illa altho(gh the two may be of e/(al si"e. -his retrognathic condition is normally corrected early in !ostnatal life by ra!id mandib(lar growth and forward dis!lacement to establish an 4ngle Class I ma%illomandib(lar relationshi!. Inade/(ate mandib(lar growth res(lts in an 4ngle Class II relation (retrognathism # and o$ergrowth of the mandible !rod(ces a class III relation (!rognathism . -he mandible can grow for m(ch longer than the ma%illa. )ene&i* basis " de'el (men& " mandible : -he de$elo!ing mandible is an (ni/(e craniofacial bone of !rofo(nd im!ortance for facial sha!e and dental occl(sion. -he de$elo!ment and mor!hogenesis of the mandible is reg(lated by 29E gene and )@E gene. -he st(dies also re$eal that s!ecial !rotein integrin and CP&; gene e%!ression is im!ortant for mandib(lar mor!hogenesis. An malies " de'el (men& : In the condition of agnathia# the mandible may be grossly deficient or absent# reflecting a deficiency of ne(ral crest tiss(e in the lower !art of the face. 4!lasia of the mandible and hyoid bone (first- and second-arch syndrome is a rare lethal condition with m(lti!le defects of the orbit and

ma%illa. Dell-de$elo!ed (albeit low-set ears and a(ditory ossicles in this syndrome s(ggest ischmeic necrosis of the mandible and hyoid bone occ(rring after the formation of the ear. -he dimin(ti$e mandible of micrognathia is characteristic of se$eral syndromes# incl(ding Pierre 'obin and cat3s cry (cri d( char syndromes# mandib(lofacial dysostosis (-reacher Collins syndrome # !rogeria# )own syndrome (trisomy &1 syndrome # oc(lomandib(lodysce!haly (?allermann9treiff syndrome # and -(rner syndrome (E6 se% chromosome com!lement . 4 central dysmor!hogenic mechanism of defecti$e ne(ral crest !rod(ction# migration# or destr(ction may be res!onsible for the hy!o!lastic mandible common to these conditions. 4bsent or deficient ne(ral crest tiss(e aro(nd the o!tic c(! ca(ses a A$ac((m#B so that the de$elo!ing otic !it (normally adjacent to the second !haryngeal arch mo$es cranially into first-arch territory and the ear becomes located o$er the angle of the mandible. )eri$ati$es of the deficient ectomesenchyme (s!ecifically the "ygomatic# ma%illary# and mandib(lar bones are hy!o!lastic# acco(nting for the ty!ical facies common to these syndromes. In Pierre 'obin syndrome# the (nderde$elo!ed (s(ally demonstrates catch-(! growth in the child. In mandib(lofacial dysostosis# deficiency of the mandible is maintained thro(gho(t growth. In (nilateral agenesis of the mandib(lar ram(s# the malformation increases with age. ?emifacial microsomia (Foldenhar syndrome also becomes more se$ere with retarded growth. Gariations in condylar form may occ(r# among them the rare bifid or do(ble condyle that res(lts from the !ersistence of se!ta di$iding the fetal condylar cartilage. 2acrognathia# !rod(cing !rognathism# is (s(ally an inherited condition# b(t abnormal-growth !henomena s(ch as hy!er!it(itarism may

!rod(ce mandib(lar o$ergrowth of increasing se$erity with age. Congential hemifacial hy!ertro!hy# e$ident at birth# tends to intensify at !(berty. Unilateral enlargement of the mandible# the mandib(lar fossa# and the teeth is of obsc(re etiology; more common is isolated (nilateral condylar hy!er!lasia. ANATOM+ OF MANDIBLE : ,$ B d- : Possesses : . /u#"a*es : a. *%ternal b. Internal . B #de#s : a. U!!er (4l$eolar b. @ower (Base . i0 /u#"a*es : a$ E1&e#nal su#"a*e : con$e% in o(tline. P#esen&s : 1. 9ym!hysis menti : a faint ridge in the midline in the (!!er !art of the body ; indicates the line of f(sion of two-hal$es of foetal bone (mandible . &. 2ental !rot(berance : a triang(lar raised area below the sym!hysis menti# the a!e% !ointing (!wards and the base downwards; forms the !rominence of chin. 0. 2ental t(bercles : a small t(bercle at each lateral angle of the mental !rot(berance. 7. 2ental foramen : a foramen below the inter$al between the 1st and &nd !remolar teeth or below the &nd !remolar tooth; faces bac.wards and slightly (!wards and leads into the mandib(lar canal. Fi$e e%it to : 2ental ner$e and $essels. 8. *%ternal obli/(e line : a faint line r(nning (!ward and bac.ward on each side from the mental t(bercle; $ery !rominent behind and contin(o(s with the anterior border of the ram(s.

Its anterior !art gi$es origin to i ii )e!ressor labi inferioris : in front. )e!ressor ang(lioris : behind. Its !osterior !art (below molar teeth and the adjoining area abo$e it gi$es origin to : B(ccinator. 1. 4rea below the obli/(e line gi$es insertion to : Platysma. ;. Incisi$e fossa : a small shallow de!ression below the incisor teeth; gi$es origin to i ii Presents : 1. 2ylohyoid line or ridge (internal obli/(e line : an obli/(e ridge r(nning forwards and downwards on each side from the 0 rd molar tooth to the sym!hsis menti; $ery !rominent behind b(t fades o(t as it !asses forwards; di$ides the internal s(rface into two areas s(bmandib(lar fossa below the line and s(bling(al fossa abo$e the line. Fi$es origin to i ii 2ylohyoid m(scle : thro(gho(t its whole length. 9(!erior constrictor m(scle of !haryn% : from its !osterior end. Pterygomandib(lar ra!he : is attached abo$e and behind its !osterior end. &. Froo$e for the ling(lar ner$e : a groo$e abo$e the mylohyoid line b(t below the last molar tooth; often made by the !assage of ling(al ner$e. 4bo$e this groo$e# the s(!erior constrictor m(scle and the !terygomandib(lar ra!he are attached. 2entalis# Part (mental sli!s of 6rbic(laris oris.

b$ In&e#nal su#"a*e : conca$e in o(tline.

0. 9(bmandib(lar fosa : a triang(lar hollow area below the mylohyoid line. @odges : i 9(bmandib(lar sali$ary gland. ii 9(bmandib(lar lym!h nodes. iii 5acial artery. 7. 9(bling(al fosa : a triang(lar conca$e area abo$e the mylohyoid line. @odges s(bling(al gland. 8. Fenial t(bercles : 7 or less in no; shar! !rojections low down in the mid-line abo$e the anterior ends of mylohoid lines; lie in !airs-& (!!er and & lower. U!!er t(bercles gi$e origin to : Feniogloss(s m(scles# one on each side. @ower t(bercles gi$e origin to : Feniohyoid m(scles# one on each side. 1. 2ylohyoid groo$e : r(ns downwards and forwards from the ram(s on to the body below the !osterior end of mylohyoid line. -ransmits : i Cer$e to mylohyoid < s(!!lies mylohyoid and anterior belly of )igastric m(scles. ii 2ylohyoid $essels ii0 B #de#s : a$ U((e# b #de# 2al'e la# (a#&0 : a In ad(lts : 11 soc.ets# , on each side# for lodging the roots of teeth# named from before bac.wards : 1. 2edial or 1st incisor &. @ateral or &nd incisor 0. Canine 7. 1st !remolar 8. &nd !remolar 1. 1st molar

;. &nd molar ,. 0rd or last molar. ICP2 )ental 5orm(la (IHincisor; CHcanine; PH!remolar; 2Hmolar . &1&0 b 4l$eolar bone aro(nd the teeth and the !ortion of s(rface adjoining it are co$ered by m(co!erioste(m to form the g(ms. c Ca$ity of the soc.et gi$es attachment to !eriodontal membrane. b$ L 3e# b #de# 2base " &he mandible0 : thic. and ro(nded; becomes contin(o(s with the lower border of the ram(s behind the 0rd molar tooth. 1 )igastric fossa : a shallow o$al de!ression on either side of the midline. Fi$es origin to anterior belly of digastric. & Insertion of !lastsyma : to the lower border and e%tending anteriorly on to the adjoining e%ternal s(rface. 0 4ttachment of in$esting layer of dee! cer$ical fascia# e%tending from the mid-line of the angle of mandible. .$ RAMU/ : 5lattened# /(adrilateral !art !rojecting (!wards from the !osterior end of the body on each side; gi$es insertion to all m(scles of mastication; dee! to the ram(s lies infra-tem!oral fossa. Possesses : . /u#"a*es : a @ateral (e%ternal b 2edial (internal 4 B #de#s : a 4nterior b Posterior c U!!er d @ower . P# *esses : a Coronoid b Condyloid

i0 /u#"a*es : a La&e#al 2e1&e#nal0 su#"a*e : flat s(rface# ro(gh thro(gho(t e%ce!t in its (!!er and !osterior !art which is smooth. P#esen&s : 1. Insertion of masseter m(scle : to the ro(gh area. &. 'elation of !arotid sali$ary gland : the smooth (!!er and !osterior !art is co$ered by !arotid sali$ary gland. b0 Medi*al 2in&e#nal0 su#"a*e : P#esen&s : 1. 2andib(lar foramen < an irreg(lar o!ening near the center which leads into the mandib(lar canal# which in t(rn leads to the mental foramen. -ransmits : inferior al$eolar (dental $essels and ner$e. &. @ing(la : a shar! thin !rocess of bone !rojecting from the medial margin of the mandib(lar foramen. Fi$es attachment to the lower end of the s!henomandib(lar ligament; the ligament is !ierced by mylohyoid $essels and ner$e. 0. 2ylohyoid groo$e : begins j(st behind the ling(al and r(ns downwards and forwards to fade o(t at the !osterior end of s(bmandib(lar fossa. @odges : i 2ylohyoid $essels : branches of inferior al$eolar $essels. ii 2ylohyoid ner$e @ a branch of the inferior al$eolar ner$e. 7. Insertion of medial !terygoid m(scle : to the ro(gh im!ression below and behind the mylohyoid groo$e.

ii0 B #de#s : a0 An&e#i # b #de# : shar! and !rominent; contin(o(s with the anterior border of the coronoid !rocess and below with the obli/(e line. Fi$es insertion to some fibres of tem!oralis. b0 P s&e#i # b #de# : thic. and ro(nded; conca$e in the middle; e%tends from the bac. of the condyloid !rocess to the midible where it becomes contin(o(s with the inferior border of the ram(s. 'elated to !arotid sali$ary gland. 4ngle of mandible : is formed where the straight lines drawn along the !osterior and inferior borders meet. Fi$es attachment to stylomandib(lar ligament. *0 U((e# 2su(e#i #0 b #de# : Presents : 1. 2andib(lar notch : in the middle &. Coronoid !rocess : in front 0. Condyloid !rocess : behind 2andib(lar notch : a wide conca$e notch in the (!!er border : its anterior margin is contin(o(s with the !osterior margin of the coronoid !rocess and its !osterior margin c(r$es (! to the lateral end of the head of mandible. -ransmits : 2asseteric $essels and ner$es. d0 L 3e# 2in"e#i #0 b #de# : contin(o(s in front with the base of mandible and behind it meets !osterior border of the ram(s at the angle of mandible. Fi$es attachment to the in$esting layer of )ee! cer$ical fascia. 'elated to facial $essels at the anterior border of masseter m(scle.

ii0 P# *esses : ,0 C # n id (# *ess : flat and triang(lar with the a!e% !ointing (!wards while the base is f(sed with the (!!er and anterior !art of the ram(s; its anterior border is contin(o(s with the anterior border of the ram(s and the !osterior border forms the anterior bo(ndary of mandib(lar notch. 1. Insertion of tem!oralis m(scle : to the a!e%# margins# whole of the medial s(rface and a !art of the lateral s(rface close to the a!e%. &. 'elation of masseter m(scle : the lateral s(rface is co$ered by the anterior fibres of the masseter m(scle. .0 C nd-l id (# *ess : !rojects (!wards from the (!!er and !osterior !art of the ram(s. 1. ?ead of mandible : thic. and e%!anded (!!er !art# broader trans$ersely than antero-!osteriorly; lined by fibrocartilage. 4rtic(lates with the artic(lar !art of mandib(lar fossa of the tem!oral bone and forms tem!oro-mandib(lar joint. -he artic(lar margins gi$e attachment to the ca!s(le and syno$ial memebrane of the joint. Presents a ro(nded t(bercle on its lateral aso!ect which gi$es attachment to the lateral ligament of the tem!oromandib(lar joint. &. Cec. of mandible : the constricted !art j(st below the head. Its lateral and !osterior as!ects adjoining the t(bercle of the head also gi$es attachment to lateral ligament of tem!oromandib(lar joint. -he anterior s(rface of the nec. is hollowed o(t into a de!ression# .nown as !terygoid fo$ea or !it which gi$es insertion to lateral !terygoid m(scle.

'elated to (i Parotid sali$ary gland on the lateral as!ect below the attachment of the ligament. ii 4(ric(lo-tem!oral ner$e abo$e and iii 2a%illary artery below on the medial as!ect. Mandibula# *anal : r(ns within the s(bstance of the bone from the mandib(lar foramen# first $ertically downwards# then obli/(ely downwards and forwards in the ram(s and then hori"ontally forwards in the body below the soc.ets of teeth with which it comm(nicates by small o!enings; ends below the inter$al between the 1st and &nd !remolar teeth by di$iding into mental and incisi$e canals the mental canal r(ns (! and behind to reach the mental foramen# the incisi$e canal r(ms forwards below the soc.ets of incisor teeth. -ransmits : the inferior# al$eolar $essels and ner$e which di$ide into mental and incisi$e $essels at the !oint of bif(rcation of the canal. /e1 de&e#mina&i n " mandible : In males : the angle of mandible is e$erted (!rojected o(twards . In females : the angle of mandible is in$erted (!rojected inwards A!e de&e#mina&i n " mandible : 2andible (ndergoes considerable changes with age of which the most im!ortant to determine the age of mandible is : 1. *r(!tion of tem!orary and !ermanent teeth in the al$eolar border of the mandible; the age of er(!tion is almost fi%ed in a$erage healthy indi$id(al. -he normal age of er(!tion of teeth in both jaws# (!!er and lower is as gi$en below <

De*idu us # &em( #a#- &ee&h (1: in each jaw# 8 on each side 1th month < @ower 1st incisors ;th month < U!!er 1st incisors ,th month < U!!er &nd incisors +th month < @ower &nd incisors 1:th month < 1st molars 1:th month < Canines &7th month < &nd molars )ental form(la &1:&
ICP2
th

Pe#manen& &ee&h (11 in each jaw# , on each side 1 year < 1st molars ;th year < 1st incisors ,th year < &nd incisors +th year < 1st !remolars 1:th year < &nd !remolars 11th year < Canines 1&th year < &nd molars
ICP2 &1&0

(wisdom teeth

4 lower tooth !recedes its corres!onding (!!er n(mber. 1st !ermanent molar er(!ts before any tem!orary tooth is shed. 9o at the age of 1 years# there are 1 teeth on one side < 1 tem!orary and 1 !ermanent (1st molar . &nd !ermanent molar er(!ts at the age of 1& years. 9o between 1 to 1& years of age# the 8 tem!orary teeth in each half-jaw are re!laced in orderfirst incisors < 1st and &nd# then molars < 1st and &nd and last of all# longrooted canine. 0rd !ermanent molar (wisdom tooth er(!ts between 1,-&8 years of age. &. Condition of soc.ets of teeth : ?ealthy teeth do not fall o(t of the soc.ets of dried bone (mandible beca(se al$eolar bone is constricted somewhat abo(t their nec.s. 4fter loss of a !ermanent tooth in life# the al$eolar bone (ndergoes atro!hy and resor!tion changes and the bottom of the soc.et fills (! with new bone. -h(s# if a tooth has fallen

o(t a loo. at the al$eolar border will tell whether the tooth was bro.en before or after death. In old age# beca(se of loss of teeth# the al$eolar bone is resorbed and the al$eolar border is red(ced to an al$eolar ridge.
Besides the abo$e two changes in the al$eolar !art# other changes in the mandible to hel! determination of age are s(mmari"ed in a tab(lated form below <

1. 2ental foramen

A& bi#&h Adul& Old a!e Cearer the lower 2idway between Cearer the (!!er border (!!er and lower border. borders. (nearer 'ight angle (abo(t 6bt(se +:: 17:: Condyloid !rocess Condyloid (nearer !rocess coronoid b(t in

&. 4ngle of the 6bt(se mandible 1,:: 0. Coronoid I Coronoid condyloid !rocesses

!rocess is larger is abo$e the le$el is abo$e the le$el of and abo$e the of the coronoid the le$el condyloid !rocess @ies a of !rocess !rocess

e%treme old age it is little '(ns bent bac.wards nearly '(ns close to the border.

7. 2andib(lar canal

abo$e the le$el !arallel with the (!!er or al$eolar of the mylohyoid mylohyoid line. line. Present; the bone 'e!resented by a Cot recogni"able or remains in two faint ridge only in absent. hal$es together fibro(s tiss(e. (nited the (!!er !art by

8. 9ym!hysis menti

-he si"e of the bone and the de!th of its body are also the !oints to be added to the list.

Clini*al * nside#a&i ns " &he mandible : I. 'adiological considerations II. 4natomical $ariations 1. 2andib(lar accessory foramina and canals &. Bifid mandib(lar condyles III. 2andib(lar endodontic related !aresthesia I$ Radi l !i*al * nside#a&i ns : -he $ario(s radiological $iews by which the !arts of mandible can be $iewed is broadly classified into < a Intraoral techni/(es b *%traoral techni/(es In intra oral techni/(es# the following are the $iews. i Intraoral !eria!ical radiogra!h (I6P4 ii Bitewing radiogra!h iii 6ccl(sal radiogra!h In e%tra oral techni/(es# the following are the $iews < i ii iii i$ $ $i 6bli/(e lateral radiogra!hs Ce!halometric )ental !anoromic tomogra!hy Com!(ted tomogra!hy -ranscranial# trans!haryngeal# transorbital etc. 2'I

II0 Ana& mi*al 'a#ia&i ns : i 2andib(lar accessory foramina and canals : 4ccessory mandib(lar foramina refer to any o!enings in the bone other than the soc.ets of the teeth# the mandib(lar foramina# the mental foramina.

Based on the literat(re# accessory canals and foramina are !re$alent in the !osterior mandible and the area of the sym!hysis and more fre/(ently on the internal than the e%ternal s(rface of the mandible. Bilateral symmetry is common. Gariations e%ist in si"e and n(mber. 6cc(rrence may change with age and racial origin. Cer$es# ne(ro$asc(lar b(ndles# arterioles and $en(les ha$e been fo(nd to occ(!y the accessory canals and foramina. Co gender differences ha$e been described. ii Bifid mandib(lar condyles : 4 re$iew of the literat(re showed that only fo(r cases ha$e been re!orted !re$io(sly as incidental findings !atients# while another fo(r cases ha$e been detected in !ost mortem material. )(e to the minimal sym!tomatology# the diagnosis of a bifid condyle (s(ally rests on radiological rather than clinical e$idence. -he s!litting of the condyles ranges from a shallow groo$e to two distinct condyles with a se!arate nec.. -he orientation of the head may be mediolateral or antero!osterior. It is belie$ed that the bifid mandib(lar condyle is a de$elo!ment anomaly and !erinatal tra(ma has been cited as a !ossible ca(se. -he genetic origin of this abnormality has been s!ec(lated as well as secondarily from a $ariety of ca(ses.

III0 Mandibula# end d n&i* 5 #ela&ed (a#es&hesia : Paresthesia is an abnormal sensation that !atients often describe as a n(mb# !ric.ly# or tingling sensation. Possible ca(ses incl(de local ner$e inj(ry# ischemia# !ress(re on the associated ner$es# and to%ins. Pareshtesia of the inferior al$eolar ner$e is rare beca(se of its (ni/(e intraosseo(s anatomy and the conse/(ent !rotection by the mandib(lar bone. 6ral !aresthesia can res(lt from s(rgical# iatrogenic# odontogenic# and systemic factors; dentoal$eolar s(rgery is the most common ca(se of inj(ry to both the inferior al$eolar and ling(al ner$es. Gario(s a(thors ha$e re$iewed the ca(ses of odontogenic-related sensory dist(rbances. Possible systemic ca(ses incl(de $iral and bacterial infections# metastatic neo!lasms# sarcoidosis# sic.le cell disease# diabetes mellit(s# sy!hilis# systemic sclerosis# bacterial endocarditis# s(rgical com!lications# accidental tra(ma# anesthetic injections# s(rgery# im!lant !lacement# orthodontic mo$ement# and endodontic !hysical and chemical tra(ma. -he great majority of endodontic associated !aresthesia ca(ses are diagnosed soon after thera!y. -hey res(lt from o$erfilling with obt(rating material# s(ch as !araformaldehyde !aste and resin sealers; also# the !assage of e(genol# sodi(m hy!ochlorite# or other chemicals into the $icinity of the mental or mandib(lar al$eolar ner$e has res(lted in !aresthesias. Paresthesia ca(sed by bacterial endoto%in release (associated with late-stage fail(re of the initial endodontic thera!y a!!ears to be e$en more rare.

CONCLU/ION : -he s(m total of what we .now abo(t the body (mandible to date re!resents a confl(ence of findings in !hysics# chemistry and biology. Interestingly# the str(ct(re and design of the h(man body is an architect(ral mar$el# in which bone is the str(ct(ral steel and the reinforced concrete of the h(man body. In f(lfilling its str(ct(ral assignments# the h(man body sol$es !roblems of design and constr(ction familier to the architect and engineer. ADhat a !iece of wor. is manB - ?amlet

NO KNOWLEDGE CAN BE MORE SATISFACTORY TO A MAN, THAN THAT OF ITS OWN FRAME, ITS PARTS, THEIR FUNCTIONS AND ACTIONS
- -?6249 J*55*'96C

COLLE)E OF DENTAL /CIENCE/


DEPARTMENT OF CON/ERVATIVE DENTI/TR+ AND ENDODONTIC/

PRE/ENTED B+ :
D#$ /iddhes3a#an V$

CONTENT/

,$ INTRODUCTION .$ DEVELOPMENT - PRE NATAL - PO/T NATAL - )ENETIC BA/I/ - ANAMOLIE/ 6$ ANATOM+ 4$ CLINCIAL CON/IDERATION/ - RADIOLO)ICAL CON/IDERATION/ - ANATOMICAL VARIATION/ - MANDIBULAR ENDODONTIC5RELATED PARE/THE/IA 7$ REFERENCE/ 8$ CONCLU/ION 9$ OHP FORMAT OF /EMINAR