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PubMed1986

Mesencephalic trigeminal sensory neurons of cat: axon pathways and structure of mechanoreceptive endings in periodontal ligament.

We injected 3H-proline into cat brainstem in order to label the entire mesencephalic trigeminal nucleus (Mes-V) for autoradiographic analysis of the size and pathways of Mes-V sensory axons and for microscopic study of Mes-V receptor structure in dental tissue. Labeled sensory axons were found in the trigeminal motor and sensory tracts and roots; approximately equal numbers of axons were found in both roots. The sensory root and all three divisions of the trigeminal nerve contained larger Mes-V axons than the motor root. Labeled Mes-V axons were found at the ganglion in the dorsomedial (infratrochlear) branch of the ophthalmic nerve but not in the ventrolateral branch. The mean diameter of Mes-V axons in periodontal ligament was 4.0 +/- 1.9 micron compared to 7.3 +/- 2.1 micron in maxillary and mandibular nerve, suggesting axonal arborization prior to innervation of ligament. Mes-V receptors in dental tissue were confined to ipsilateral periodontal ligament close to the root apex, with greater innervation on the posterior side. Receptor incidence was moderate for most teeth; however, maxillary first and second incisors and maxillary and mandibular canines had focal areas with remarkably dense innervation. No labeled axons were found in pulp of any ipsilateral teeth, and none was found in any contralateral dental tissue. EM-autoradiography demonstrated that Mes-V axons form unencapsulated Ruffini-like mechanoreceptors in periodontal ligament. The preterminal axons were small and myelinated. Neighboring bundles of unmyelinated axons and rare encapsulated endings were not labeled. The labeled mechanoreceptors branched to varying degrees among the ligament fibers; they contained numerous mitochondria and glycogen particles, as well as some vesicles and rare multivesicular bodies. They were surrounded by special Schwann cells that formed one or several layers around the ending. The endings were exposed to the basal lamina at numerous sites and occasionally extended fingers beyond the lamellar Schwann cells to contact ligament collagen.

Animals↗
PubMed1995

Central and peripheral nervous complications of dental treatment.

This review outlines the complications involving the central or peripheral nervous system arising from dental procedures reported in the last decade. By far the commonest complications were related to intraoperative mechanical peripheral nerve injury. Trauma to branches of the mandibular nerve occurring during oral operations may potentially result in varying degrees of hypoesthesia, paresthesia, dysesthesia or in chronic pain syndromes. An increase in malpractice suits related to such a complication has been recognized in the late years. A warning of the possibility of occurrence of this complication should to be given to all patients undergoing risky procedures as part of the process of obtaining informed consent to operation. Mandibular third molar extraction seems to be alone the most hazardous procedure related to mechanical nerve injuries and also with anesthesiological accidents. Severe but rather infrequent infectious (meningitis, brain abscess and cavernous sinus thrombophlebitis) and anesthesiological complications (occular and facial palsies, optic nerve injury and complications related to general anesthesia) were also reported in this period.

Central Nervous System Diseases↗
PubMed2002

The incidence of basal sphenoid bony bridges in dried crania and cadavers: their anthropological and clinical relevance.

The aim of this study was to investigate the incidence of the pterygospinous and pterygoalar bony bridges and the variations in these bony bridges among Anatolians. A total of 452 adult dry skulls (258 males and 194 females) of the Anatolian population were investigated for both the pterygospinous and the pterygoalar bony bridges. In 80 of the 452 dry skulls (37 male and 43 female), it was possible to inspect the cranial cavity. In these skulls, sellar and sphenopetrous bridges were also investigated. In addition to this, the mandibular nerve of 9 fixed cadavers was carefully dissected and the distribution of its branches was determined on both sides. Complete pterygospinous osseous bridges were found in 5.5% of the samples and complete pterygoalar bridges in 4.9%. In the dry skulls with removed calvaria, complete sellar osseous bridges were found on both sides in 34.2% of specimens, complete pterygospinous bridges in 8.8% and complete pterygoalar bridges in 7.5%. No complete sphenopetrous bridges were found. In the cadaveric study, nerve entrapment due to a pterygoalar ligament on the left side was found in one cadaver. Such variations should be kept in mind in clinical complaints such as mandibular neuralgia, especially during chewing.

Anthropology, Physical↗
PubMed1997

Simultaneous osseous genioplasty and meloplasty.

A review was done of the records of 50 patients who had osseous genioplasty performed at the same sitting as face lifting and, in many cases, submental lipectomy over a 20-year period by the senior author. The types of genioplasties were sliding advancement (40), lengthening with interpositional bone graft (7), and reduction (3). In 9 patients, chin implants were removed, generally because of inadequate chin projection or implant erosion. Three patients were operated on under local anesthesia, the remainder under general anesthesia. Associated procedures, done in 46 patients, included rhinoplasty, forehead lifting, blepharoplasty, lateral canthopexy, excision of buccal fat pads, reduction mammaplasty, and abdominoplasty. In 4 patients, associated maxillofacial procedures were performed, including Le Fort I and III osteotomies, two-jaw surgery, mandibular advancement with sagittal splitting, and orbital expansion. The perceived advantages of osseous genioplasty were greater versatility in dealing with problems in other than the sagittal plane, the possibility of greater chin projection, and a tightening of the submental musculature. Complications occurred in 10 patients. These included two hematomas requiring aspiration in the office, a prolapsed submandibular gland requiring later excision, a transient weakness of the marginal mandibular nerve, a transient numbness of the lower lip on one side, four revisions of scars resulting from the face lifting, and one localized wound infection in the parasymphyseal area that resolved with oral antibiotics. The most common complaint, which came from 8 female patients at some time from 1 month to 3 years postoperatively, was that the chin was "too strong." In 6 of these patients, most of whom were operated on early in the series, some of the chin projection was reduced by burring. Osseous genioplasty can be performed safely along with face lifting and submental lipectomy. The degree of advancement necessary in aesthetic surgical patients is generally less than that required in reconstructive patients. Patient satisfaction is great unless the chin is overly advanced.

Abdomen↗
PubMed1984

Clinical and anatomic observations on the relationship of the lingual nerve to the mandibular third molar region.

The position of the lingual nerve in the mandibular third molar region was measured and photographed in 34 cadaver dissections and 256 cases of third molar extraction. In 17.6% of the dissections the lingual nerve was found at the level of the alveolar crest or higher. Horizontally the nerve contacted the lingual plate of the third molar in 62% of the specimens. Of 256 patients, the nerve was visualized above the height of the lingual plate of the lower third molar in 12 (4.6%). These results document the vulnerability of the lingual nerve as it passes medially to the mandibular third molar.

Adult↗
PubMed2002

Delayed onset of altered sensation following dental implant placement and mental block local anesthesia: a case report.

A case of a delayed-onset post-operative altered sensation of the mental nerve is reported with speculations as to etiology. There is a discussion concerning intraoperative radiographs and osteotomy positioning. When postoperative altered sensation occurs, etiologic considerations should always include local anesthetic administration technique. The importance of pulp testing from the first molar to the contralateral lateral incisor is key to determining whether the deficit is in the mandibular nerve or only the mental nerve, which may be a result of mental block local anesthetic administration and not implant placement. This differentiation may be important in treatment and/or legal exposure. The altered sensation was probably caused by the mental block anesthetic technique. The partial anesthetic area in this case was probably a result of crossover innervation from the contralateral mental nerve.

Anesthesia, Dental↗
PubMed2006

Review of complications due to foramen ovale puncture.

We aim to evaluate the mechanisms responsible for complications during trigeminal rhizotomy via foramen ovale puncture. Ten dry skulls and 10 skull-base specimens were investigated in the present study. In cadaveric skull-base specimens, the anatomical relationships between the foramen ovale, mandibular nerve and Gasserian ganglion and the surrounding neurovascular structures were investigated intradurally. The distance between the foramen ovale and Gasserian ganglion was measured as 6 mm. The abducent nerve, adjacent to the anterior tail of the petrolingual ligament, was observed passing along the lateral wall of the cavernous sinus. Advancement of the catheter more than 10 mm from the foramen ovale is likely to damage the internal carotid artery and the abducent nerve at the medial side of the petrolingual ligament. Thermocoagulation of the lateral wall of the cavernous sinus may damage the cranial nerves by heat, giving rise to pareses.

Anatomy, Regional↗
PubMed1994

Study of pterygospinosus muscle in human fetuses.

The arrangement of the pterygospinosus muscle was analyzed in 5 human fetuses. The pterygospinosus muscle extends from the posterior border of the lateral lamina of the pterygoid process to Meckel's cartilage. Such an arrangement would permit its action on the joint formed by Meckel's cartilage and the incus of the middle ear. The pterygospinosus muscle is a remnant of the masticatory muscle group. The relationships of the pterygospinosus muscle with the mandibular nerve and its branches and the maxillary artery and its branches were analyzed.

Computer Simulation↗
PubMed1987

Postherpetic gustatory flushing and sweating.

An 11-year-old girl who had suffered right facial herpes zoster at the age of 6 years was left with anesthetic scars in the distribution of the third division of the trigeminal nerve. Since then, certain tastes provoked flushing and sweating localized to the scarred areas, lasting for 10 to 15 minutes after a latency of a few seconds. The response was evoked most readily from the ipsilateral posterior section of the tongue and was virtually abolished by local administration of anesthesia to the tongue. It remained unaltered after blockade of the sphenopalatine and stellate ganglia but was diminished by blockade of the mandibular nerve. Thermoregulatory sweating and flushing were diminished in the scarred areas. Patchy destruction of sympathetic fibers, which are known to accompany peripheral trigeminal nerve branches, and reinnervation of the affected areas by parasympathetic fibers that normally mediate salivation may explain the phenomenon. It is thus analogous to the gustatory flushing and sweating that may follow damage to the auriculotemporal nerve in the region of the parotid gland (Frey's syndrome).

Child↗
PubMed1999

Morphology, topography and cytoarchitectonics of the otic ganglion in the spotted suslik (Spermophilus suslicus, Güldenstaedt 1770).

Using the thiocholine method of Koelle and Friedenwald and histological techniques the otic ganglion of the spotted suslik (Spermophilus suslicus, Güldenstaedt 1770) from the province of Zamość was studied. The ganglion was found to be a single oval cluster of neurocytes, situated at the medial and posterior surface of the mandibular nerve just above the maxillary artery. The ganglion is composed of typical ganglionic neurons in a compact arrangement and without a thick connective-tissue capsule.

Animals↗
PubMed1991

[Perineural application of glycerol and phenol-glycerol. Histomorphologic-morphometric study].

In a long-term study the effect of glycerol and phenol-glycerol on rats mandibular nerve was analysed. The substances were applicated perineurally. Nerves treated with glycerol did not show any severe pathological changes. Only the number of desintegrations of myelin seemed to be more pronounced. This, however, was a transitary effect. On the contrary, nerves treated with phenol-glycerol showed the familiar picture of degeneration and regeneration. According to our results it can be stated that the perineural application of glycerol has no toxic and destructive effect on the nerve. Therefore, the perineural glycerol blocking will not cause severe side-effects and the method can be recommended in the therapy of chronic facial pain.

Animals↗
PubMed1982

The development of the peripheral trigeminal innervation in Xenopus embryos.

The development of the ophthalmic, maxillary and mandibular nerves has been followed in Xenopus laevis embryos from the first emergence of growth cones from the trigeminal ganglia until the establishment of functional innervation of the skin or cement gland. The course of each main nerve is highly predictable and follows pre-existing openings between blocks of other tissues. The development of the mandibulary nerve was observed most easily. Like that of the other trigeminal nerves it falls into three stages: (1) A pioneer neurite emerges and a nerve forms as other, later neurites fasciculate with this. (2) On reaching the inside surface of the cement gland the neurites separate and penetrate holes in the basal lamina. (3) The neurites grow between the cells they will innervate and form free nerve endings. The scanning EM observations have been confirmed by electrical recordings from trigeminal neurones. The role of pioneer fibres and substrate guidance are discussed.

Action Potentials↗
PubMed2001

Morphology, topography and cytoarchitectonics of the otic ganglion in Egyptian spiny mouse (Acomys cahirinus, Desmarest).

Using the thiocholine method of Koelle and Friedenwald and histological techniques, the otic ganglion in Egyptian spiny mouse (Acomys cahirinus, Desmarest) was studied. The ganglion was found to be a single oval cluster of neurocytes, situated at the medial and posterior surface of the mandibular nerve just above the maxillary artery. The ganglion is composed of typical ganglionic neurons in compact arrangement without a thick connective-tissue capsule.

Animals↗
PubMed2006

Facial nerve morbidity after retrograde nerve dissection in parotid surgery for benign disease: a 10-year prospective observational study of 136 cases.

We evaluated the facial nerve function in 136 patients who had had retrograde nerve dissection during parotidectomy for benign disease. One week after the operation 90 patients (66%) had some weakness of the facial nerve. After 1 month 52 (38%) had facial nerve paresis. After 3 months 114 (84%) had recovered fully and 21 (16%) had minor nerve paresis. After 6 months 135 (99%) had normal nerve function. One patient had persistent marginal mandibular nerve paresis.

Adenoma↗
PubMed2002

[Rosai-Dorfman disease accompanying hypertrophic cranial pachymeningitis with an early symptom of right peripheral facial palsy].

We experienced a rare case of sinus histiocytosis with massive lymphoadenopathy (Rosai-Dorfman disease) accompanying hypertrophic cranial pachymeningitis. The patient is a 64-year-old woman with an early symptom of rt. peripheral facial palsy. She had a 4-month history of headache with a 5-week history of numbness in the rt. supraorbital nerve area, and lost her weight by 10 kg in 2 months. She developed rt. trochlea nerve palsy and numbness in the lt. mandibular nerve area. Laboratory findings showed that ALP, LDH and CRP were higher than normal. Of CT, MRI and MRA, the images of her head were normal. However, the Gd-enhanced MRI only showed a diffuse pachymeningeal enhancement. After about 3 months from the onset of rt. peripheral facial palsy, she died of DIC of unknown etiology. As a result of examinations in anatomical pathology, she was diagnosed as having sinus histiocytosis with massive lymphoadenopathy (Rosai-Dorfman disease). There were a large number of histiocytes on the pachymeninx. These findings suggest that hypertrophic cranial pachymeningitis caused multiple cranial neuropathy. We emphasize that use of Gd-enhanced MRI in the early stage is important for diagnosis.

Facial Paralysis↗
PubMedDate not supplied

[Palpable orbital subcutaneous masses in chronic inflammatory demyelinating polyneuropathy. MRI and neurophysiological study of multiple peripheral nerve swelling].

We report a 46-year-old woman with chronic inflammatory demyelinating polyneuropathy (CIDP) in whom swelling of the first branch of the trigeminal nerves in the bilateral orbits were observed as subcutaneous masses in the upper eyelids. The disease developed when the patient was 33 years old, and weakness of the four limbs, double vision, unilateral hypoglossal neuroparalysis, and unilateral facial paralysis frequently occurred during the course of the illness. On nerve conduction studies, conduction block was detected in the motor nerves. Steroid therapy and immunoglobulin treatment improved the symptoms. At 43 years old, subcutaneous phymas were noted in the bilateral upper eyelids, and fat-suppressed MRI detected the phymas localized along the upper region of the superior straight muscle in the bilateral orbits, and the muscles were slightly compressed downward. The masses branched in the orbits, and were diagnosed as nerve swelling of the supraorbital nerve, the first branch of the trigeminal nerve. Fat-suppressed MRI also identified nerve swelling of the extracranial maxillary and mandibular nerves. However, the patient had no subjective sensory disturbance in the trigeminal nerve region. Blink reflex did not induce R1 and R2 exhibited low amplitude and delayed latency. MRI confirmed asymmetric nerve swelling in the regions of the bilateral median nerves with motor nerve conduction block. Lumbar MRI detected nerve swelling in the peripheral nerves distant from the lumbar ganglion. MRI detected no nerve swelling in the arachnoid space such as the cervical cord, thoracic cord, or cauda equina. Aggravation of CIDP was treated with steroids and immunoglobulin. Diplopia occasionally appeared, but was not consistent with aggravation of CIDP. The bilateral supraorbital nerves remained unchanged for three years on MRI.

Chronic Disease↗