Clinical Significance of an Incidentally Detected Lateral Lingual Foramen on Cone-Beam Computed Tomography (CBCT): A Case Report and Review of Pertinent Literature

The lateral lingual foramen (LLF) is an often-overlooked anatomical variant of the mandible with important clinical implications during implant placement and oral surgical procedures. Unlike the consistently present midline lingual foramen, LLF exhibits marked variability in its prevalence, morphology, and neurovascular content, contributing to potential complications when unrecognized. This case report describes an incidental LLF identified during routine cone-beam computed tomography (CBCT) undertaken for the preoperative evaluation of mandibular third molars in a healthy 21-year-old woman. CBCT revealed a distinct LLF (0.93 mm in diameter) positioned lingual to the mental foramen and apical to the premolar roots, with a corresponding lateral lingual canal (LLC), 6.39 mm in length. The canal demonstrated continuity between the lingual cortical bone and soft tissues of the floor of the mouth, suggesting the presence of a neurovascular bundle branching from the mental or inferior alveolar neurovascular complex. The patient subsequently underwent uneventful maxillary extractions and mandibular coronectomies, after which she was advised regarding the significance of the incidental LLF for any future osteotomy, genioplasty, or implant procedures in the interforaminal region. A review of pertinent literature highlights wide variability in LLF prevalence, typical localization in the canine-premolar region, and the potential for significant hemorrhage, especially when the LLF diameter exceeds 1 mm or when associated with atrophic mandibles. CBCT consistently emerges as the imaging modality of choice for accurate detection, morphological characterization, and preoperative risk assessment. Recognition of LLF and LLC is critical for preventing bleeding complications, neurosensory deficits, and life-threatening airway compromise during anterior mandibular surgery and implantology.