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Ostrowski P, Bonczar M, Wilk J, Michalczak M, Czaja J, Niziolek M, Sienkiewicz J, Szczepanek E, Chmielewski P, Iskra T, Gregorczyk-Maga I, Walocha J, Koziej M. The complete anatomy of the lingual nerve: A meta-analysis with implications for oral and maxillofacial surgery. Clin Anat 2023; 36:905-914. [PMID: 36864652 DOI: 10.1002/ca.24033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
Lingual nerve (LN) injury during surgical procedures in the third molar region warrants a detailed study of its common pathway and important variations. Therefore, the objective of this study was to analyze and compile the multiple anatomical variations of the LN for use in oral and maxillofacial surgery. It is anticipated that the results of the present meta-analysis may help to minimize the possible complications when performing procedures associated with this anatomical entity. Major online databases such as PubMed, Web of Science, Scopus, Embase were used to gather all relevant studies regarding the LN anatomy. The results were established based on a total of 1665 LNs. The pooled prevalence of the LN being located below the lingual/ alveolar crest was found to be 77.87% (95% CI: 0.00%-100.00%). The LN was located above the lingual/ alveolar crest in 8.21% (95% CI: 4.63%-12.89%) of examined nerves. The most common shape of the LN was established to be round with a prevalence of 40.96% (95% CI: 23.96%-59.06%), followed by oval at 37.98% (95% CI: 23.98%-53.02%) and flat at 25.16% (95% CI: 12.85%-39.77%). In conclusion, we believe that this is the most accurate and up-to-date study regarding the anatomy of the LN. The LN was found to be located below the lingual/alveolar crest in 77.87% of the cases. Furthermore, the LN was found to enter the tongue under the submandibular duct in 68.39% of the cases. Knowledge about the anatomy of the LN is crucial for numerous oral and maxillofacial procedures such as during the extraction of the third molar.
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Affiliation(s)
- Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Jakub Wilk
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Michalczak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Julia Czaja
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Martha Niziolek
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Justyna Sienkiewicz
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Elżbieta Szczepanek
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Tomasz Iskra
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
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Rodriguez Betancourt A, Samal A, Chan HL, Kripfgans OD. Overview of Ultrasound in Dentistry for Advancing Research Methodology and Patient Care Quality with Emphasis on Periodontal/Peri-implant Applications. Z Med Phys 2023; 33:336-386. [PMID: 36922293 PMCID: PMC10517409 DOI: 10.1016/j.zemedi.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Ultrasound is a non-invasive, cross-sectional imaging technique emerging in dentistry. It is an adjunct tool for diagnosing pathologies in the oral cavity that overcomes some limitations of current methodologies, including direct clinical examination, 2D radiographs, and cone beam computerized tomography. Increasing demand for soft tissue imaging has led to continuous improvements on transducer miniaturization and spatial resolution. The aims of this study are (1) to create a comprehensive overview of the current literature of ultrasonic imaging relating to dentistry, and (2) to provide a view onto investigations with immediate, intermediate, and long-term impact in periodontology and implantology. METHODS A rapid literature review was performed using two broad searches conducted in the PubMed database, yielding 576 and 757 citations, respectively. A rating was established within a citation software (EndNote) using a 5-star classification. The broad search with 757 citations allowed for high sensitivity whereas the subsequent rating added specificity. RESULTS A critical review of the clinical applications of ultrasound in dentistry was provided with a focus on applications in periodontology and implantology. The role of ultrasound as a developing dental diagnostic tool was reviewed. Specific uses such as soft and hard tissue imaging, longitudinal monitoring, as well as anatomic and physiological evaluation were discussed. CONCLUSIONS Future efforts should be directed towards the transition of ultrasonography from a research tool to a clinical tool. Moreover, a dedicated effort is needed to introduce ultrasonic imaging to dental education and the dental community to ultimately improve the quality of patient care.
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Affiliation(s)
| | - Ankita Samal
- Department of Radiology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Hsun-Liang Chan
- Department of Periodontology and Oral Medicine, Dental School, University of Michigan, Ann Arbor, MI, USA
| | - Oliver D Kripfgans
- Department of Radiology, Medical School, University of Michigan, Ann Arbor, MI, USA
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Muacevic A, Adler JR, Hu K, Zan E, Tjan A, Kim S. Delineation of Radiation Therapy Target Volumes for Lingual Nerve Involvement. Cureus 2022; 14:e32993. [PMID: 36712766 PMCID: PMC9878932 DOI: 10.7759/cureus.32993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
It is important for radiation oncologists to be able to accurately contour the lingual nerve pathway, as it is commonly involved in oral cavity cases. However, most atlases do not give a detailed account of the entire lingual nerve pathway as it traverses from the oral cavity, through the masticator space, to the base of the skull. Three experienced head and neck cancer specialists (two radiation oncologists and one neuroradiologist) examined anatomy textbooks, institutional magnetic resonance imaging (MRI), and computed tomography (CT) images of normal anatomy and also recurrences along the lingual nerve pathway to determine "anchor points" to help radiation oncologists contour more confidently. We found five anchor points to help radiation oncologists contour the lingual nerve pathway: At the level of the foramen ovale, the lateral pterygoid, the transition between lateral and medial pterygoid, the medial pterygoid (within the pterygomandibular space), and the oral cavity. Five anchor points with easily identifiable anatomy are established that radiation oncologists can use to contour the lingual nerve pathway more confidently.
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Aljamani S, Youngson C, Jarad F, O'Neill F. Electrical stimulation to clinically identify position of the lingual nerve: results of 50 subjects with reliability and correlation with MRI. Oral Maxillofac Surg 2022; 26:253-260. [PMID: 34255234 PMCID: PMC9162997 DOI: 10.1007/s10006-021-00985-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Recently we described mapping of the lingual nerve clinically in patients using electrical nerve stimulation. This paper reports results of a larger study with inter- and intra-observer reliability and comparison with positional measurements from magnetic resonance imaging (MRI). METHODS In 50 healthy participants, measurements were taken when subjects felt a tingling sensation in the tongue induced by a stimulation probe over the lingual nerve. Three positions were measured in relation to the third molar. Measurement reliability was tested for both inter-observer and intra-observer agreement and positional data of the lingual nerve measured clinically was also compared with nerve position as measured from MRI scans. RESULTS Out of 50 participants, 96 nerves (49 = left/47 = right) were included in the study. The lingual nerve was identified in 90% (87) of this sample. The mean of height of the nerve in points A, B and C were 9.64 mm, 10.77 mm and 12.34 respectively. Inter-and intra-observer agreement was considered to be good to excellent (ICC = 0.8-0.96). Agreement between nerve mapping measured values and MRI measured values was good (ICC < 0.6). CONCLUSION This technique may prove useful for the clinical determination of lingual nerve position prior to procedures in the third molar region.
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Affiliation(s)
- Sanaa Aljamani
- Restorative Unit, School of Dentistry, University of Liverpool, Liverpool, UK
- School of Dentistry, University of Jordan, Amman, Jordan
| | - Callum Youngson
- Restorative Unit, School of Dentistry, University of Liverpool, Liverpool, UK
| | - Fadi Jarad
- Restorative Unit, School of Dentistry, University of Liverpool, Liverpool, UK
| | - Francis O'Neill
- Oral Surgery Unit, School of Dentistry, University of Liverpool, Liverpool, UK.
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Al-Haj Husain A, Valdec S, Stadlinger B, Rücker M, Piccirelli M, Winklhofer S. Preoperative visualization of the lingual nerve by 3D double-echo steady-state MRI in surgical third molar extraction treatment. Clin Oral Investig 2021; 26:2043-2053. [PMID: 34586501 PMCID: PMC8816737 DOI: 10.1007/s00784-021-04185-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Abstract
Objectives To assess the lingual nerve (LN) visualization using a 3D double-echo steady-state MRI sequence (3D-DESS). Materials and methods Three readers prospectively evaluated the LN for its continuous visibility in 3D-DESS MRI in 19 patients with an indication for removal of mandibular impacted third molars, using a 5-point scale (4 = excellent to 0 = none). Six LN anatomical intermediate points (IP) were selected and checked for their detectability by a 4-point scale (4 = yes to1 = no). Inter- and intra-rater agreement was evaluated using intraclass correlation coefficient and percentage of agreement. Results The average nerve continuity score was 3.3 ± 0.46. In 35% of the cases, the entire course was continuously visible. In 10%, the proximal and 60%, the distal part of the nerve was not continuously visible. Inter- and intra-reader agreement was good (ICC = 0.76, ICC = 0.75). The average detectability score of all IP was 3.7 ± 0.41. From IP1 to IP5, the detectability was excellent; meanwhile, IP6 had lower visibility. The inter- and intra-reader percentage of agreement was 77% and 87%. Conclusions The 3D-DESS sequence allowed accurate and continuous visualization of the LN with high reproducibility in more than one-third of the patients. This could improve the preoperative clarification of the LN position and thereby reduce complications during dentoalveolar surgical interventions. Clinical relevance 3D-DESS MRI might be beneficial in clinical scenarios where the second molar is elongated or presents a difficult rotational position while simultaneously having a close positional relationship to the third molar. Thereby, osteotomy performed more lingually, indicating extended lingual flap detachment may increase the risk of LN damage. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04185-z.
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Affiliation(s)
- Adib Al-Haj Husain
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Silvio Valdec
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Bernd Stadlinger
- Clinic of Cranio-Maxillofacial and Oral Surgery, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland
| | - Martin Rücker
- Clinic of Cranio-Maxillofacial and Oral Surgery, University Hospital of Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Marco Piccirelli
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Sebastian Winklhofer
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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Petroni G, Passaretti A, Zaccheo F, Nardo DD, Testarelli L, Cicconetti A. Lingual Flap Protection during Third Molar Surgery: A Literature Review. Eur J Dent 2021; 15:776-781. [PMID: 34388831 PMCID: PMC8630958 DOI: 10.1055/s-0041-1730042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this review was to analyze how the retraction and protection of lingual flap (LF+) could influence the incidence of lingual nerve injury (LNI) during third molar extraction, as compared with protocols that do not involve handling of lingual tissue (LF). A literature review was performed from the “Medline” and “Scopus” medical databases, using the keywords “lingual nerve” and “third molar surgery.” From the selected articles, the mean values for transitory and permanent LNI’s incidence were elaborated, taking into account the group treated with LF+ technique and the group treated with LF technique. Of 480 articles, 11 studies were included in the review. The LF+ group counted 3,866 surgeries and it resulted in a transitory LNI’s mean incidence of 2.98 ± 0.03% and a mean incidence of 0.1 ± 0.003% for permanent LNI. The LF group counted 5,938 surgeries with, respectively, 1.92 ± 0.02 and 0.49 ± 0.006% of transitory and permanent LNI’s incidence mean values. The results of this study suggest that the application of LF+ techniques reduces the risk of damage and injuries of lingual nerve.
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Affiliation(s)
- Giulia Petroni
- Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy
| | | | - Fabrizio Zaccheo
- Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy
| | - Dario Di Nardo
- Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy
| | - Luca Testarelli
- Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy
| | - Andrea Cicconetti
- Department of Oral and Maxillofacial Sciences, School of Dentistry, Sapienza University of Rome, Rome, Italy
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Bigagnoli S, Greco C, Costantinides F, Porrelli D, Bevilacqua L, Maglione M. CBCT Radiological Features as Predictors of Nerve Injuries in Third Molar Extractions: Multicenter Prospective Study on a Northeastern Italian Population. Dent J (Basel) 2021; 9:dj9020023. [PMID: 33669928 PMCID: PMC7924829 DOI: 10.3390/dj9020023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/04/2021] [Accepted: 02/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Neurological alterations are one of the main complications occurring after the third molar extractions. The aim of this prospective multicenter cohort study was to find out Cone Beam Computed Tomography (CBCT) features and distribution of neurological complications in patients undergoing lower third molar surgery and to determine the radiological and patient-related factors that could be correlated to the occurrence of inferior alveolar and lingual nerves injury. Material and Methods: 378 patients who underwent lower third molar extraction from March 2018 to March 2019 were included. Clinical and radiological data were collected. CBCT features were recorded following Maglione et al. classification. Symptoms and characteristics of patients who experienced neurological alterations were evaluated. Results: 193 patients needed a second-level radiological exam (CBCT). In these patients, the most common feature was Maglione class 3: a higher frequency of apical or buccal mandibular canals in direct contact with the tooth was observed. 3.17% of the patients developed a neurological complication. Maglione class 4, increased age, and operative time were all positively correlated with neurological alterations. Conclusions: while the buccal or apical position of the mandibular canal was the more common findings, the lingual position was found to have a higher correlation with a negative outcome. Age and operative time were also found to be risk factors for developing nerve injury in the considered population.
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Affiliation(s)
- Stefano Bigagnoli
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Christian Greco
- Unit of Dentistry, Merano Hospital, via Giacomo Rossini 5, 39012 Merano, Italy;
| | - Fulvia Costantinides
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
| | - Davide Porrelli
- Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy;
| | - Lorenzo Bevilacqua
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
- Correspondence:
| | - Michele Maglione
- School of Specialization in Oral Surgery, Unit of Oral Surgery, Department of Medical, Surgical and Health Sciences, University of Trieste, Piazza dell’Ospitale 1, 34129 Trieste, Italy; (S.B.); (F.C.); (M.M.)
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Clinical Reasoning for the Examination and Physical Therapy Treatment of Temporomandibular Disorders (TMD): A Narrative Literature Review. J Clin Med 2020; 9:jcm9113686. [PMID: 33212937 PMCID: PMC7698332 DOI: 10.3390/jcm9113686] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023] Open
Abstract
The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.
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Onal M, Colpan B, Elsurer C, Bozkurt MK, Onal O, Turan A. Is it possible that direct rigid laryngoscope-related ischemia-reperfusion injury occurs in the tongue during suspension laryngoscopy as detected by ultrasonography: a prospective controlled study. Acta Otolaryngol 2020; 140:583-588. [PMID: 32223688 DOI: 10.1080/00016489.2020.1743353] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Tongue-related complications can be seen in suspension laryngoscopy (SL) procedures.Aims/objectives: This study aimed to detect tongue edema associated with the pressure exerted by a rigid direct laryngoscope by measuring the tongue area using ultrasonography (USG) in patients undergoing SL procedures.Material and methods: The study group included 31 patients and the control group consisted of 33 patients. Submental USG examinations of the tongue in the coronal plane were performed. In the study and control groups, the first examination (TA1) was done immediately after intubation and the second examination (TA2) was done after the surgery procedure but before extubation. The USG results regarding tongue area for both the groups were compared.Results: The study and control groups significantly differed in terms of the postoperative tongue area measurements (TA2), as well as tongue edema (based on the TA2 - TA1) values.Conclusions and significance: Direct rigid laryngoscopes may cause tongue edema in SL procedures which was demonstrated by the USG. This tongue edema can be a result of ischemia-reperfusion injury in the tongue due to the pressure exerted by a direct rigid laryngoscope. This study is the first to demonstrate the possible role of USG examination in determining the side effects of SL procedures on the tongue. Trial Registration ClinicalTrials.gov Identifier: NCT04205253.
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Affiliation(s)
- Merih Onal
- Department of Otolaryngology, Selcuk University, Konya, Turkey
| | - Bahar Colpan
- Department of Otolaryngology, Selcuk University, Konya, Turkey
| | - Cagdas Elsurer
- Department of Otolaryngology, Selcuk University, Konya, Turkey
| | | | - Ozkan Onal
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
- Department of Anesthesiology and Reanimation, Selcuk University, Konya, Turkey
| | - Alparslan Turan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
- Department of General Anesthesia, Cleveland Clinic, Cleveland, OH, USA
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Aljamani S, Youngson C, Jarad F, O'Neill F. Development of a method to clinically identify the position of the lingual nerve relative to the third molar region. TRANSLATIONAL RESEARCH IN ANATOMY 2020. [DOI: 10.1016/j.tria.2020.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Szalma J, Lovász BV, Lempel E, Maróti P. Three-Dimensionally Printed Individual Drill Sleeve for Depth-Controlled Sections in Third Molar Surgery. J Oral Maxillofac Surg 2019; 77:704.e1-704.e7. [PMID: 30610836 DOI: 10.1016/j.joms.2018.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/09/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Abstract
During surgical third molar removal and coronectomy procedures, tooth sectioning is an important and, in some cases, an inferior alveolar nerve-endangering step. This article introduces a drilling sleeve that was printed according to the individual tooth-sectioning situation preoperatively, using diagnostic cone-beam computed tomography data. Not only did the sleeve function in our case as a mark on the drill; it was also a reliable physical limiter, serving as a determinant of the required depth during tooth sectioning. This fast and cost-effectively produced drilling sleeve may help younger colleagues when the depth of tooth sections should be precisely controlled.
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Affiliation(s)
- József Szalma
- Associate Professor and Head of Department, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary.
| | - Bálint Viktor Lovász
- PhD Student, Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary
| | - Edina Lempel
- Associate Professor, Department of Restorative Dentistry and Periodontology, University of Pécs, Pécs, Hungary
| | - Péter Maróti
- PhD Student, Department of Biophysics, University of Pécs, Pécs, Hungary
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Menziletoglu D, Tassoker M, Kubilay-Isik B, Esen A. The assesment of relationship between the angulation of impacted mandibular third molar teeth and the thickness of lingual bone: A prospective clinical study. Med Oral Patol Oral Cir Bucal 2019; 24:e130-e135. [PMID: 30573722 PMCID: PMC6344005 DOI: 10.4317/medoral.22596] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/29/2018] [Indexed: 11/11/2022] Open
Abstract
Background Our purpose was to investigate the relationship between the angulation of mandibular third molars and the thickness of the lingual bone, which can affect the risk of lingual nerve damage during lower third molars surgical extraction. Material and Methods This study consisted of 104 patients (42 males and 62 females), aged between 18-42 years (24.67 ± 6.11 years). Cone Beam Computed Tomography (CBCT) images were taken for preoperative assessment. The teeth were divided into four groups according to their positions: mesioangular, distoangular, vertical and horizontal. Lingual bone thickness around impacted teeth were measured at three points: cementoenamel junction (CEJ) of the mandibular second molar, mid-root of the impacted third molar, and apex of the impacted third molar root. Two predisposing factors of lingual nerve damage were recorded: lingual bone perforated by the impacted tooth and lingual bone thinner than 1 mm. Additionally, buccolingual angulations of the teeth in each group were measured.
Impacted mandibular third molars were removed in usual way. One week after surgery, the patients were evaluated regarding lingual nerve paresthesia. Results None of the 104 patients experienced paresthesia, including the ones who had teeth with close proximity with lingual nerve. The mean thickness of bone was 1.21±0.63 mm at CEJ of the second molar; 1.25±1.02 mm at the mid-root; and 1.06±1.31 mm at the apex. Horizontally impacted teeth had thinner lingual bone at mid-root level (p=0.016). Buccolingual angulated teeth were more often associated with perforated lingual bone (p=0.002). Buccolingual and mesial/distal angulation had negative correlation with lingual bone thickness (p<0.05). Conclusions As the buccolingual and mesiodistal angulations increase, lingual bone thickness decreases. Horizontally impacted teeth seemed to compromise the integrity of the lingual bone more than impacted teeth in other positions. During the surgery, thin or perforated lingual bone may result in displacement of the impacted tooth lingually. Key words:Lingual bone, impacted third molar, cone beam computed tomography, angulation, paresthesia.
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Affiliation(s)
- D Menziletoglu
- Necmettin Erbakan University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Karacigan Mah Ankara Cad No:74, Karatay- KONYA/ TURKEY,
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Pippi R, Spota A, Santoro M. Medicolegal Considerations Involving Iatrogenic Lingual Nerve Damage. J Oral Maxillofac Surg 2018; 76:1651.e1-1651.e13. [DOI: 10.1016/j.joms.2018.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022]
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14
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Buch HA. Lingual nerve: In search of a landmark for its position. Clin Anat 2017; 30:1009-1012. [PMID: 28524244 DOI: 10.1002/ca.22921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/12/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Hasmukh A Buch
- Human Anatomist F2 Pratishtha Apts, Near Shyamal Row Houses Five, Adj. Satellite Ring Road, Ahmedabad, Gujarat, 380015, India
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Pippi R, Spota A, Santoro M. Prevention of Lingual Nerve Injury in Third Molar Surgery: Literature Review. J Oral Maxillofac Surg 2017; 75:890-900. [DOI: 10.1016/j.joms.2016.12.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/23/2016] [Accepted: 12/24/2016] [Indexed: 12/13/2022]
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Sittitavornwong S, Babston M, Denson D, Zehren S, Friend J. Lingual Nerve Measurements in Cadaveric Dissections: Clinical Applications. J Oral Maxillofac Surg 2017; 75:1104-1112. [PMID: 28215852 DOI: 10.1016/j.joms.2017.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Lingual nerve (LN) injury is quite prevalent despite its long-known anatomic course. The purpose of this study was to accurately predict the LN pathway by identifying and measuring close anatomic landmarks; these measurements should help lessen the incidence of LN injury. MATERIALS AND METHODS LN dissection was carried out on 15 halved cadaver skulls (total, 28 specimens). RESULTS On average, the LN position was approximately 7 mm below the alveolar crest at the distal end of the mandibular second molar, 5.5 mm anterior to the lingula, and 14.6 mm distal to the alveolar crest at the mandibular second molar. From the base of the skull, the LN traveled 5 mm anteriorly to the inferior alveolar nerve and inferiorly to the posterior attachment of the mylohyoid muscle (approximately 1.5 cm distal to the mandibular second molar), where it turned anteromedially and traveled 7 mm inferiorly to the alveolar crest at the mandibular second molar. CONCLUSION Given the multiple procedures by dental practitioners and maxillofacial surgeons, the LN is at high risk for injury. This study validates the proximity of the LN to anatomic structures commonly encountered during head and neck procedures.
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Affiliation(s)
- Somsak Sittitavornwong
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL.
| | - Michael Babston
- Resident, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Douglas Denson
- Resident, Department of Oral and Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Steven Zehren
- Professor, Cell, Development and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | - Jonathan Friend
- Program Coordinator, Gross Anatomy Laboratory and Surgical Laboratory, University of Alabama at Birmingham, Birmingham, AL
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Tolstunov L, Brickeen M, Kamanin V, Susarla SM, Selvi F. Is the angulation of mandibular third molars associated with the thickness of lingual bone? Br J Oral Maxillofac Surg 2016; 54:914-919. [DOI: 10.1016/j.bjoms.2016.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/10/2016] [Indexed: 11/26/2022]
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Al-Amery SM, Nambiar P, Naidu M, Ngeow WC. Variation in Lingual Nerve Course: A Human Cadaveric Study. PLoS One 2016; 11:e0162773. [PMID: 27662622 PMCID: PMC5035068 DOI: 10.1371/journal.pone.0162773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/29/2016] [Indexed: 11/18/2022] Open
Abstract
The lingual nerve is a terminal branch of the mandibular nerve. It is varied in its course and in its relationship to the mandibular alveolar crest, submandibular duct and also the related muscles in the floor of the mouth. This study aims to understand the course of the lingual nerve from the molar area until its insertion into the tongue muscle. This cadaveric research involved the study of 14 hemi-mandibles and consisted of two parts: (i) obtaining morphometrical measurements of the lingual nerve to three landmarks on the alveolar ridge, and (b) understanding non-metrical or morphological appearance of its terminal branches inserting in the ventral surface of the tongue. The mean distance between the fourteen lingual nerves and the alveolar ridge was 12.36 mm, and they were located 12.03 mm from the lower border of the mandible. These distances were varied when near the first molar (M1), second molar (M2) and third molar (M3). The lingual nerve coursed on the floor of the mouth for approximately 25.43 mm before it deviated toward the tongue anywhere between the mesial of M1 and distal of M2. Thirteen lingual nerves were found to loop around the submandibular duct for an average distance of 6.92 mm (95% CI: 5.24 to 8.60 mm). Their looping occurred anywhere between the M2 and M3. In 76.9% of the cases the loop started around the M3 region and the majority (69.2%) of these looping ended at between the first and second molars and at the lingual developmental groove of the second molar. It gave out as many as 4 branches at its terminal end at the ventral surface of the tongue, with the presence of 2 branches being the most common pattern. An awareness of the variations of the lingual nerve is important to prevent any untoward complications or nerve injury and it is hoped that these findings will be useful for planning of surgical procedures related to the alveolar crest, submandibular gland/ duct and surrounding areas.
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Affiliation(s)
- Samah M Al-Amery
- Dept. of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Phrabhakaran Nambiar
- Dept. of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Murali Naidu
- Dept. of Anatomy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wei Cheong Ngeow
- Dept. of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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20
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Møystad A, Bjørnland T, Friedland B, Donoff RB. Ultrasonographic pilot study of mental foramen size, with and without postoperative neurosensory dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:275-80. [PMID: 26166032 DOI: 10.1016/j.oooo.2015.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/04/2014] [Accepted: 04/16/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the ability of a portable ultrasound system to visualize the mental foramen in patients with unilateral neurosensory dysfunction after third molar removal. STUDY DESIGN In 20 patients, an ultrasound scanner (13 MHz linear-array transducer) was used to measure the mental foramen. The anteroposterior diameter was calculated on both sides, and differences between injured and contralateral sides were tested. Intrarater and interrater reliability were calculated using Intraclass Correlation Coefficient (ICC). RESULTS We found a relatively high reliability on interindividual observations (ICC ≥0.89) and intraindividual observations (ICC ≥0.76). The average diameter on the injured sides was significantly smaller than the control sides. Subjective sensibility was not significantly correlated to the dimension of the mental foramen. CONCLUSION The results indicate a reduced size of the mental foramen, as determined by ultrasonography, in patients with permanent neurosensory dysfunction. These findings have to be verified in a larger number of patients.
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Affiliation(s)
- Anne Møystad
- Professor, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Norway.
| | - Tore Bjørnland
- Professor and Chairman, Department of Oral Surgery and Oral Medicine, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Norway
| | - Bernard Friedland
- Assistant Professor, Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - R Bruce Donoff
- Professor and Dean, Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Multivariate assessment of site of lingual nerve. Br J Oral Maxillofac Surg 2015; 53:347-51. [PMID: 25662169 DOI: 10.1016/j.bjoms.2015.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 01/15/2015] [Indexed: 12/15/2022]
Abstract
Injury to the lingual nerve can cause debilitating symptoms. The nerve lies in the retromolar region and its anatomical site can vary within patients and according to sex, age, and dentate status. To our knowledge, no previous studies have recorded its course from multiple bony landmarks and examined the association between age, dentate status, and sex, in the same sample. We dissected 30 white cadavers and took primary and secondary reference points from the internal oblique ridge. We measured the distance to the lingual nerve in sagittal, vertical, and horizontal planes, and recorded the position where the nerve was closest to the lingual plate. We dissected 46 hemimandibles (23 male, mean age 79 years, range 52-100) of which 26 were from the left side. Mean (SD) sagittal, vertical, and horizontal distances from the primary reference point were 9.29 (3.41)mm, 9.15 (3.87)mm, and 0.57 (0.56)mm, respectively. Mean (SD) vertical and horizontal distances from the secondary point were 7.79 (5.45) mm and 0.59 (0.64)mm, respectively. The proximity of the nerve to the lingual plate varied widely (range -13.00 to 15.17mm from the primary reference point). Dentate status was significant for the sagittal measurement from the primary point, and the vertical measurement from the secondary point. Differences in age, sex, or site of the contralateral nerve were not significant (n=16 pairs). Our findings suggest that the site of the nerve is consistent between and within subjects for sex and age, but not for dentate status. The association between the nerve and the lingual plate varied, which suggests that care must be taken when operating in the area.
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Bokindo IK, Butt F, Hassanali J. Morphology and Morphometry of the Lingual Nerve in Relation to the Mandibular Third Molar. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojst.2015.51002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nakamori K, Tomihara K, Noguchi M. Clinical significance of computed tomography assessment for third molar surgery. World J Radiol 2014; 6:417-423. [PMID: 25071882 PMCID: PMC4109093 DOI: 10.4329/wjr.v6.i7.417] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/27/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery. Third molar surgery is warranted when there is inadequate space for eruption, malpositioning, or risk for cyst or odontogenic tumor formation. Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues. Due to developments in medical engineering technology, computed tomography (CT) now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery. Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation, whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve. Multiple factors, including demographic, anatomic, and treatment-related factors, influence the incidence of nerve injury during or following removal of the third molar. CT assessment of the third molar prior to surgery can identify some of these risk factors, such as the absence of cortication between the mandibular third molar and the inferior alveolar canal, prior to surgery to reduce the risk for nerve damage. This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery.
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Joo W, Yoshioka F, Funaki T, Mizokami K, Rhoton AL. Microsurgical anatomy of the trigeminal nerve. Clin Anat 2013; 27:61-88. [PMID: 24323792 DOI: 10.1002/ca.22330] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/05/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Wonil Joo
- Department of Neurosurgery; Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine; Seoul South Korea
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Fumitaka Yoshioka
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Takeshi Funaki
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Koji Mizokami
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Albert L. Rhoton
- Department of Neurosurgery; University of Florida; Gainesville Florida
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Szalma J, Bata Z, Lempel E, Jeges S, Olasz L. Quantitative pixel grey measurement of the "high-risk" sign, darkening of third molar roots: a pilot study. Dentomaxillofac Radiol 2013; 42:20130160. [PMID: 23775927 DOI: 10.1259/dmfr.20130160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Our aim was to examine the panoramic darkening of the root, which is a "high-risk" sign, using quantitative measurements of pixel grey values to determine different aetiological backgrounds, namely inferior alveolar nerve (IAN) exposure with or without groove formation of the third molar roots or thinning/fenestration of the lingual cortex (LCTF). METHODS 38 impacted third molars that had been surgically removed and had darkened roots on panoramic radiographs were included in this retrospective case-control study. 15 IAN exposure cases were selected for the case group, and 23 cases with proven lingual cortical thinning or fenestration were chosen for the control group. The mean pixel grey values of selected areas in the dark band (D) and control areas within the same roots (R) were determined with the ImageTool (University of Texas Health Science Center, San Antonio, TX) software. The differences in pixel values (R-D) of the IAN and LCTF groups were analysed using the Mann-Whitney U-test and Pearson's χ(2) test. RESULTS The medians of the R-D pixel values were 45.7 in the IAN group and 34.3 in the LCTF group, whereas the interquartile ranges were 12.0 (IAN) and 18.3 (LCTF) (p < 0.001). The R-D critical value at which the outcomes differed significantly was 38. If the differences in pixel grey values (R-D) were higher than 38, the chance of IAN exposure was approximately 32 times higher than the chance of LCTF (χ(2) test, p < 0.001; odds ratio, 32.0; 95% confidence interval, 3.5-293.1). CONCLUSIONS The pre-operative prediction of IAN exposure or lingual cortical thinning in cases with "darkening" is possible based on pixel grey measurements of digital panoramic radiographs.
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Affiliation(s)
- J Szalma
- Department of Oral and Maxillofacial Surgery, University of Pécs, Pécs, Hungary.
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