Median Lingual Foramen, a new midmandibular cephalometric landmark

Purpose: In asymmetrical mandibles, it is often challenging to identify the mandibular midline. The median lingual foramen (MLF) is located at the midline of the anterior mandible. The purpose of this study is to evaluate the reproducibility of identifying the MLF compared to conventional landmarks on cone beam computed tomography's (CBCT's) to mark the mandibular midline. Material and Methods: Ten symmetrical class II, 10 symmetrical class III, ten asymmetrical class II and 10 asymmetrical class III patients were included. On CBCTs, the cephalometric landmarks menton, pogonion, genial tubercle and MLF were identified twice by two observers. Results: A high intra- and interobserver reproducibility was found for all landmarks, the highest being the MLF. The gain in accuracy is 0.998 mm, 0.824 mm and 0.361 mm compared to pogonion, genial tubercle and menton, respectively (P-value <.05). Conclusion: MLF is a reliable and reproducible landmark to indicate the midline of the mandible, particularly in Class II asymmetric mandibles.