The mandibular lingula, historically termed the spine of Spix, represents a critical anatomical landmark in oral and maxillofacial surgery. This comprehensive review synthesises findings from major studies spanning 25 years (2000-2025), encompassing 11,937 + mandibular sides across 19 + populations from six continents. The lingula serves as the primary landmark for inferior alveolar nerve blocks (IANB), sagittal split ramus osteotomy, and various orthognathic procedures. Significant morphological variations exist, with five distinct shapes documented: triangular, truncated, nodular, assimilated, and the recently described bridge/M-shaped morphology (Stipo et al., 2022). A critical methodological bias is evident: dry bone studies predominantly report triangular shapes (39%), while Cone-Beam Computed Tomography (CBCT) studies reveal a nodular predominance (50.6%) in many populations. The internal oblique or mylohyoid ridge has emerged as a reliable alternative landmark (95.7% visibility) and yields superior IANB success rates (97.3%) compared with traditional methods (∼85%). Furthermore, the antilingula is critically evaluated and found to have limited value as a sole landmark. However, it may serve as a supplementary guide when used with appropriate posterior safety margins. This review establishes evidence-based, population-specific surgical protocols, emphasizes the unreliability of traditional assumptions regarding bilateral symmetry, and includes critical appraisal of recent data regarding age-related mandibular remodelling. Comprehensive meta-analytic data representing 4694 subjects provides the most comprehensive morphometric reference values currently available.

To catalogue the ossification mechanisms operating along the proximal-distal axis of the human mandible and integrate them into a unified regional framework. Narrative review of embryological, molecular, transcriptomic, and clinical genetics evidence identified through structured searches of PubMed, Scopus, and Web of Science. The type of evidence (human, animal, in vitro, or combined) underpinning each major finding was tracked. Five non-overlapping mechanisms operate across ten mandibular regions: (i) intramembranous ossification of the body, ramus, and coronoid process; (ii) parachondral ossification, defined as intramembranous bone formation in mesenchyme adjacent to Meckel's cartilage (MC) under MC-derived paracrine guidance (BMP5, BMP7, FGF7, SEMA3A from the intermediate MC) and used as the operative descriptor for mandibular body formation; (iii) endochondral ossification of primary cartilage at the symphysis and anterior MC midsegment, via chondrocyte-to-osteoblast transdifferentiation; (iv) endochondral ossification of secondary cartilage at the condylar and angular processes, with viable hypertrophic chondrocytes and chondroid bone; and (v) perichondral ossification at the MC surface. Transdifferentiation executes mechanism (iii) and is not a separate mode. Posterior MC degradation proceeds via autophagy, apoptosis, and chondroclastic resorption, with independent chondral centres near dental primordia contributing further. Treacher Collins syndrome, cleidocranial dysplasia, and Pierre Robin sequence reflect disruptions at different mechanistic levels. The mandible is a composite structure employing multiple ossification modes in a region-specific manner; parachondral ossification most accurately characterises mandibular body formation. The framework carries translational implications for tissue engineering, distraction osteogenesis, and prenatal molecular rescue, evidenced only preclinically in a Treacher Collins mouse model.

Background/Objectives: To establish normative CTA (computed tomography angiography) morphometry of the maxillary artery (MA) relative to the lateral pterygoid muscle (LPM) and mandibular landmarks in a European population. Methods: Bilateral CTA datasets from 164 patients (328 sides; mean age 67.2 ± 13.0 years) were analysed retrospectively. The MA course was classified relative to the inferior head of the LPM as superficial (S) or deep (D); patients were assigned to three bilateral types (Type 1: S + S; Type 2: D + D; Type 3: S + D), and MA–gonial angle, MA–mandibular notch, and MA–lingula distances were measured. Results: The MA was superficial in 61.0% of sides, with no transpterygoid course; Type 1 predominated (48.8%). The MA–gonial angle distance was 34.53 ± 5.31 mm, with marked sex dimorphism (males: 36.74 mm vs. females: 31.35 mm; p < 0.0001). Looping occurred on at least one side in 34.8% of patients, and the MA lay superior to the mandibular notch in 83.4% of superficial sides. The MA–lingula distance was 8.03 ± 2.54 mm; non-retrotuberosity looping was strongly associated with proximity below 5 mm (OR = 9.95). Conclusions: A three-type bilateral classification of the MA course, the first normative MA–gonial angle dataset, and the looping–proximity association provide actionable data for surgical risk stratification in infratemporal and mandibular ramus procedures.