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Diagnosing and managing neuropathic pain with associated sensory aberrations can be aggravating and frustrating for both the dentist and the patient. The teeth and intraoral and extraoral tissues can be affected if neuritis is located in the maxillary or mandibular nerve branches. Dentists should be aware of a neuritic etiology for tooth pain because an incorrect diagnosis can lead to ineffective and unnecessary dental work.
The common representation of the auriculotemporal nerve is either that of a single posterior branch of the mandibular nerve or of two roots that envelope the middle meningeal artery. Our observation in the anatomy of the auriculotemporal nerve on 32 dissections (16 cadaveric heads) of the infratemporal fossa included: one specimen with four roots (3.1%), three specimens with three roots (9.4%), 12 specimens with two roots (37.5%), and 16 specimens with one root (50%). Furthermore, a connecting nerve branch was observed between auriculotemporal and inferior alveolar nerves in four specimens, and in another auriculotemporal nerve case, between the upper and lower roots. In the cadaver of a 70-year-old male, a four-rooted auriculotemporal nerve variation was found. These four branches lay to the posterior, combined at the posterosuperior of the maxillary and superficial temporal arteries and formed a ganglion-like knot. From this knot, four branches stemmed and ran to the temporomandibular joint, external acoustic meatus, zygoma, and parotid gland. The knot was larger and thicker than expected; thus, it was removed and stained with haematoxylin-eosin (H&E) and S100 for histological studies. This structure was not a true ganglion but a structure formed by fusion of nerve fibers.
In this article, the anatomic and physiologic characteristics and clinical syndromes involving the auriculotemporal nerve (ATN) are reviewed. The ATN is a terminal branch of the mandibular nerve (third division of the trigeminal nerve). The syndrome of ATN neuralgia (ATNa), which is characterized by attacks of paroxysmal, moderate to severe pain on the preauricular area, often spreading to the ipsilateral temple, is discussed in this article. The classification of ATNa under the Second Edition of the International Classification of Headache Disorders, as well as our personal experience in diagnosing and treating this syndrome, also are reviewed.
For an accurate assessment of jaw movement, it is crucial to understand the comprehensive formation of the masticatory muscles with special reference to the relationship to the disc of the temporomandibular joint. Detailed dissection was performed on 26 head halves of 14 Japanese cadavers in order to obtain precise anatomical information of the positional relationships between the masticatory muscles and the branches of the mandibular nerve. After complete removal of the bony elements, the midmedial muscle bundle in all specimens and the discotemporal muscle bundle in 6 specimens, derivatives of the temporalis, which insert into the disc were observed. On the anterior area of the articular capsule and the disc of the temporomandibular joint, the upper head of the lateral pterygoid, the midmedial muscle bundle of temporalis and the discotemporal bundle of temporalis were attached mediolaterally, and in 3 specimens the posterosuperior margin of the zygomaticomandibularis was attached to the anterolateral area of the disc. It is suggested that these muscles and muscle bundles contribute to various mandibular movements. Although various patterns of the positional relationships between the muscles and muscle bundles and the their innervating nerves are observed in the present study, relative positional relationships of the muscles and muscle bundles and of nerves of the mandibular nerve are consistent. A possible scheme of the developmental formation of the masticatory muscles based on the findings of the positional relationships between the muscles and the nerves is presented.
This paper presents a retrospective study carried out on a sample of 100 patients affected by pleomorphic adenoma of the parotid gland and treated at the Department of Maxillofacial Surgery at the University of Rome "La Sapienza" between January 1, 1989 and December 31, 1997. For the diagnosis of this neoformation, cytological tests were performed on material taken from the neoformation using fine needle aspiration and ultrasound scan. In some selected cases, a CT examination of the head and neck with medium contrast or Nuclear Magnetic Resonance (NMR) was carried out. This study sets out to examine the most suitable treatment to be followed for the removal of the pleomorphic adenoma of the parotid gland. In 56 cases the patients underwent a superficial, conservative parotidectomy. Forty one patients had a total parotidectomy with the facial nerve left intact and one patient had a total parotidectomy where the marginal mandibular nerve of the facial nerve was damaged. The remaining two patients involved in the study were suffering from a recurrent pleomorphic adenoma and in these two cases a total parotidectomy was performed where the facial nerve was killed. The removal of the cranial nerve VII in these patients proved necessary because the nerve fibers had adhered to the surrounding scar tissue of the tumor, either after previous surgery or due to repeated chronic phlogosis of the gland.
The topographical anatomy of the maxillary artery in the infratemporal fossa is investigated. 194 preparations from 98 adult specimens are examined (53 male, 45 female). Our important findings are the following: 1. In 29 of 96 specimens (in 2 cases only one side was available) the maxillary artery is located on the outer side of the external pterygoid muscle on one side of the head whereas on the opposite side of the same head it is situated on the inner side of the external pterygoid muscle. 2. in our dissections the maxillary artery is running more frequently medial to the external pterygoid muscle (107 out of 194 preparations; 55.2%) 3. in 2 cases the relation of the maxillary artery to the branches of the mandibular nerve is considerable interesting. 4. An accessory meningeal artery is found in 9 cases (4.6%). 5. In 2 cases the maxillary artery perforates the lingual nerve.
Facial nerve injuries are rare complications after orthognathic surgery. A literature review shows that such damages can develop with various mechanisms and are usually transient. Two cases of delayed facial paralysis after mandibular osteotomy with spontaneous recovery are reported.
OBJECTIVE: To evaluate the use of the buccinator musculomucosal flap in the reconstruction of defects of the oral cavity and oropharynx. DESIGN: Prospective case series of 8 patients during a 1-year period with an average follow-up of 1 year. Six anatomical dissections were performed on 3 fresh cadaver heads to investigate the neurovascular supply to the flap. SETTING: Academic tertiary referral medical center. RESULTS: The buccinator musculomucosal flap was used in the reconstruction of 8 defects of the oral cavity, retromolar trigone, and soft palate. There was 1 partial flap necrosis that occurred in a patient who had previously received radiation therapy and who healed secondarily without sequelae. No patient experienced difficulties with mastication or oral competence. All patients reported light single-point touch sensation over the flap 2 weeks after surgery. Cadaveric dissections using latex or india ink injections demonstrated the posterior neurovascular supply from the buccal artery, a branch of the internal maxillary artery, and the buccal nerve, a branch of the mandibular nerve. CONCLUSIONS: The buccinator musculomucosal flap is a dependable local sensate flap with a well-defined neurovascular pedicle that can be used in a variety of intraoral reconstructions obviating the need for distal tissue harvest.
In order to determine the incidence of cranial nerve injury during carotid endarterectomy, preoperative and postoperative otolaryngologic examinations were performed in a prospective series of 240 operations. Thirty patients experienced a total of 38 cranial nerve injuries, involving the recurrent laryngeal nerve in 14, the hypoglossal nerve in 13, the marginal mandibular nerve in six and the superior laryngeal nerve in five. Postoperative dysfunction affected one cranial nerve in 25 patients, two nerves in four and three nerves in one patient. Most cranial nerve injuries were asymptomatic or mild in severity, resolved in one to 12 months and probably were caused by intraoperative retraction.
Variations in the anatomy of the inferior alveolar nerve were seen in 2 of the 20 dissections of the infratemporal fossa in 10 cadavers. A connecting nerve branch that originated from the auriculotemporal nerve joined the inferior alveolar nerve on both sides. The second part of the maxillary artery passed between the mandibular nerve, the root of the inferior alveolar nerve, and the connecting nerve branch which formed a loop. The maxillary artery seemed to be entrapped. Neurovascular entrapment can cause pain and numbness. Anatomical variations in this region should be kept in mind, particularly in cases of failed treatment of trigeminal neuralgia.
The results of peripheral nerve repair have been greatly improved in the last few years following the introduction of micro-surgery and increased application of free autologous nerve transplants. In the field of oral surgery, a rich experience has been made in plastic and reconstructive repair. The inferior alveolar nerve is endangered by a series of mandibular fractures, with fracture lines running along the nerve canal. For plastic repair of the inferior alveolar nerve, we interpose an autologous transplant from the greater auricular nerve.
1. Secretory nerve fibres to the parotid gland of the dog have been found in the adventitia of the internal maxillary artery. In dogs under chloralose anaesthesia the course of these fibres from the mandibular nerve to the gland was determined by electrical stimulation at different sites. Secretion induced by these nerves was abolished by atropine but not by hexamethonium.2. In dogs in light barbiturate anaesthesia parotid secretion was evoked reflexly by pouring citric acid on the tongues. After division of the auriculo-temporal nerve and the nerves on the artery this secretion disappeared in about half the experiments and was greatly reduced in the others.3. The maximal secretory rate which could be obtained reflexly from the normally innervated parotid gland was first estimated in light barbiturate anaesthesia. Chloralose was then given and the auriculo-temporal nerve and the nerves on the artery were electrically stimulated together; in about half the experiments this could produce secretion at a rate as high as that obtained reflexly.4. By separate and simultaneous stimulation of different sets of nerve fibres convergence of the secretory fibres to the glandular cells could be demonstrated.5. It is concluded that a large number of post-ganglionic, cholinergic secretory fibres to the canine parotid gland run on the internal maxillary artery. In some dogs a small number of fibres seem to have escaped detection. Possibly they may reach the gland by way of the facial nerve.
The factors initiating the onset of desmal jaw formation are not known. The purpose of the present report was to examine the correlation between the appearance of ossification and nerve tissue in human fetal jaws. This was done through elaboration of similarities in occurrence of tissue types at four different sites of initial bone formation in the jaws. Radiological and histochemical methods applied to the jaws of 26 human embryos/fetuses revealed that nerve tissue appeared in the jaws before bone tissue. Early bone formation occurred in close relation to the mandibular nerve, the maxillary nerve, the palatine nerve, and the naso-palatine nerve. It is suggested that the foramina (mental foramen, infraorbital foramen, palatal foramen, and incisive foramen) are the areas of incipient bone formation, and that the sequence in bone formation corresponds to the sequence in the development of nerve fibers from the trigeminal ganglion.
A unilateral resection of the mandibular nerve (n = 20) was made 10-14 days before investigation of the contribution of afferent nerves in vasodilator reactions in the dental pulp. Lower canine teeth were subjected to various stimuli and pulp blood-flow responses monitored by laser Doppler flowmetry. An absence of response to bipolar electrical (5 impulses, 50 microA, 5 ms, 2 Hz) stimulation on the tooth surface was used to demonstrate a successful chronic nerve lesion. Local application of capsaicin (10(-4) M) in a deep dentinal cavity induced a long-lasting increase in pulpal blood flow in control teeth only. Bradykinin (10(-3) M) induced significantly larger responses in control than in denervated teeth (58.3 +/- 9.8% and 24.5 +/- 4.9%, respectively, p less than 0.005, n = 8); in addition, the onset was slower and the duration of the response significantly (60%) shorter than in control teeth. Intermittent grinding of surface dentine instantly increased flow in control teeth by 53.0 +/- 12.5% (n = 12) whereas in denervated teeth the response was delayed and significantly (70%) smaller. Deeper preparation produced responses of similar magnitude in control and denervated teeth (69 and 50%, respectively) but the onset was delayed in denervated teeth. Low-intensity ultrasonic stimulation caused vasodilation in intact teeth (38% increase) but had no effect in denervated teeth. This effect was abolished after local anaesthetic (mepivacaine) injection. Sympathectomy (n = 3) did not influence stimulation-induced blood-flow responses in the dental pulp.(ABSTRACT TRUNCATED AT 250 WORDS)
We describe a case of Burkitt's cell acute lymphoblastic leukemia presenting with the bilateral numb chin syndrome as the initial symptom of the disease. Postmortem study of the trigeminal nerve showed heavy infiltrations of leukemic cells and destruction of axon and myelin by leukemic cells in the mandibular nerve.
This article is about the different iatrogenic (or others) mechanical and/or chemical trauma that can affect the mandibular nerve and which can lead to paresthesia. Depending on the different causes of the paresthesia, the prognosis for the nerve sensitivity regeneration will vary: in some cases treatment is necessary to make the symptoms disappear, in others expectation will be the rule and the prognosis is very poor.
A case of Herpes zoster of the mandibular nerve in an 80 year old man is reported. Herpes zoster infection affecting only the mandibular branch of the trigeminal nerve is rare. It is proposed that the distribution of lesions is a consequence of a unique latent site of the virus within neurons of the gasserian ganglion innervating the mandibular division of the trigeminal nerve.
It has been suggested that nerve endings emanating from the dental nerve plexus of the jaw might be involved in the formation of tooth germs. In the present study we examine the effect of unilateral denervation on the formation of tooth germs in the lower jaw of a polyphyodont teleost--the cichild Tilapia mariae. Repeated inspection of the lower jaw dentition in normal animals over a period of about 300 days showed that the functional time of an average individual tooth is 101 days. In operated animals, the functional time was normal on the unoperated side, but on the denervated side tooth turnover ceased about 100 days after surgery. Radiographic plates from lower jaw specimens revealed that mineralized replacement teeth were present on the unoperated side, but not on the denervated side, 300 days after denervation. Light microscopic examination of semi-thin transverse sections from decalcified plastic-embedded lower jaws showed that soft-tissue tooth primordia and nerves were lacking on the denervated side, while present within the undisturbed half-jaw. It is concluded that the local presence of mandibular nerve branches is necessary for the formation of tooth germs in the lower jaw of the cichlid T. mariae.