The infraorbital canal issues a small branch on its lateral face close to its midpoint to allow passage of the anterior superior alveolar nerve. This small canal, sometimes called the canalis sinuosus, runs forward and downward to the inferior wall of the orbit, lateral to the infraorbital canal and medially bent to the anterior wall of the maxillary sinus, passing below the infraorbital foramen. Anatomical variations in the maxilla are rarely described in the literature and, in most cases, are related to the nasopalatine canal. This article describes a rare anatomical variation of the presence of a bilateral accessory canal extending from the nasal cavity lateral wall to an accessory foramen located on the hard palate, adjacent to the maxillary lateral incisor observed in cone beam computed tomography (CBCT) images. This case is an anatomical variation of the anterior superior alveolar nerve (canalis sinuosus). Identification of individual anatomical variations, especially on CBCT, may help the surgeon to avoid injuries to nerves during implant placement.

The accuracy of vertical and horizontal measurements, using CBCT (i-CAT) for the four protocols, was shown to be comparable with the measurements performed on the dry mandible.

The canalis sinuosus (CS) is a neurovascular canal, a branch of the infraorbital canal through which the anterior superior alveolar nerve passes. There are no studies or case reports of anatomical variations related to this canal. A rare case of anatomical variation in the CS is reported that was detected by cone beam computed tomography done in a 47-year-old female as a pre-operative workup before dental implants. In this case, in the region slightly medial to tooth 23, a wide accessory branch from the CS was observed, running an intraosseous course in the inferior and posterior direction up to a foramen located in the hard palate, slightly medial in relation to tooth 23. The location of this branching, as well as its neurovascular component, is important for dental implant planning because of its proximity to the upper teeth. Identification of neurovascular bundles is fundamental to avoid complications for the patient.

The aim of this paper is to describe the case of a 53-year-old female patient, with renal failure who has been on dialysis for 6 years and developed severe secondary hyperparathyroidism and brown tumor of the maxilla and mandible, confirmed by incisional biopsy. Parathyroidectomy was indicated as a result of rapid growth of the tumor and the maintenance of laboratory findings. Despite the normalization of serum parathyroid hormone and alkaline phosphatase, tumor regression was slow and patient's important functional and esthetic deficits persisted. Excision of the mandible tumor was conservative. Osteoplasty was recommended because during a 5-year follow-up there was regression of the lesion, decreased pain, bleeding, and tooth mobility.

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