Pathosis or Additional Maxillary Neurovascular Channel? A Case Report

This case report highlights an incidental finding of an anatomic variation of a neurovascular channel in close proximity to the maxillary right permanent lateral incisor (tooth #7). A 32-year-old patient presented with discomfort and a history of trauma in childhood to the right maxillary central incisor (tooth #8). A periapical radiograph of tooth #8 revealed an incidental finding of a radiolucent area in the apical one third of the right maxillary lateral incisor (tooth #7) root with the appearance of inflammatory apical root resorption. A cone-beam computed tomographic scan taken to assess the suspected area of resorption revealed this to be a neurovascular channel within the bone passing distal to the apex of tooth #7, which has been superimposed over the root of tooth #7 on the periapical radiograph. This case report highlights that additional bone channels are a common finding in the maxillary alveolus. These channels can in fact be the canalis sinuosus (or branches of it), a bone channel that is a frequent anatomic variant arising from the infraorbital canal. The canalis sinuosus has been reported rarely in the literature, but it should be considered to be a potentially common finding in the maxillary incisal region. Clinicians are made aware of the presence of additional neurovascular bone channels such as the canalis sinuosus when interpreting radiographs for assessing periapical status of teeth and for surgical planning in the anterior maxilla.