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PubMed1983

A reappraisal of the interposed bone graft augmentation of the atrophic mandible.

A follow-up on 148 patients who had undergone an interposed bonegraft augmentation of the atrophic mandible is presented. The first group consisted of 38 patients who underwent surgery 4-6 years ago. The second group of 70 patients has a follow-up period of 3 to 4 years. The third group of 40 patients was followed up from 2 to 3 years postoperatively. The phenomenon of post-operative bone resorption which continues for many years postoperatively, is discussed. The high incidence of nerve disturbances as found in this study is regarded as unacceptable. The dissection of the mandibular nerve out of its canal (decompression) in order to avoid nerve damage during the operation is not found to be of any advantage. A modified technique is recommended to circumvent this problem.

Adult↗
PubMed1986

Bilateral lingual nerve anesthesia following mandibular third molar extractions.

Despite the vulnerability of the lingual nerve to damage during third molar surgery, the incidence of permanent nerve anesthesia is relatively low. Bilateral lingual nerve anesthesia has not yet been reported in the literature. A case of bilateral lingual nerve anesthesia following mandibular third molar exodontia is presented, along with possible explanations as to the cause of anesthesia.

Adult↗
PubMed1993

The prevalence of altered sensation associated with implant surgery.

Trauma to branches of the mandibular nerve may occur during oral surgical procedures and result in varying degrees of altered sensation. Since mandibular implant surgery involves mucoperiosteal flap elevation and bone removal during site preparation, complications involving altered sensation are to be expected. This study replicated a retrospective questionnaire study carried out in Toronto, Canada, and showed that the prevalence of altered sensation in implant patients in Adelaide, Australia (36%) was consistent with that found in Toronto (37%). These data reflect the incidence of altered sensation reported for similar oral surgical procedures and suggest that further characterization of this complication following mandibular implant surgery is necessary.

Adult↗
PubMedDate not supplied

Tilting of posterior mandibular and maxillary implants for improved prosthesis support.

Rehabilitation of atrophied edentulous arches with endosseous implants in the posterior regions is often associated with anatomic problems such as jaw shape and location of the mental loop, mandibular canal, and maxillary sinuses. The purpose of this investigation was to modify the method for implant placement in the posterior part of the jaws to extend fixed implant-connected prostheses further distally, and to reduce the length of cantilevers in complete-arch prostheses without transpositioning the mandibular nerve or performing bone grafting in the maxilla. Forty-seven consecutive patients were treated with implants (25 patients/36 mandibular implants, 22 patients/30 maxillary implants) placed in tilted positions. They were followed a mean of 40 months (mandibles) and 53 months (maxillae). In the mandible, implants close to the mental foramina were tilted posteriorly approximately 25 to 35 degrees. In the maxilla, the posterior implants were placed close to and parallel with the sinus walls and were titled anteriorly/posteriorly approximately 30 to 35 degrees. Patients gained a mean distance of 6.5 mm of prosthesis support in the mandible and 9.3 mm in the maxilla, as a result of implant tilting. There were no implant failures in mandibles. The cumulative success rates in the maxilla at 5 years were 98% for tilted implants and 93% for non-tilted implants. Paresthesias of the mental nerve were observed on 4 sides during the first 2 to 3 weeks after implant placement. Analysis of the load distribution in one mandibular case showed no significant difference between tilted and the non-tilted implants, and the improved prosthesis support was confirmed. Satisfactory medium-term results concerning osseointegration and significant extension of prosthesis support show that the method can be recommended. This technique may allow for longer implants to be placed with improved bone anchorage.

Adult↗
PubMed2001

The trigeminal nerve. Part IV: the mandibular division.

The mandibular or third division of the trigeminal nerve is the largest of the three divisions. It is considered a mixed nerve. That is, like the ophthalmic and maxillary divisions, the mandibular conveys afferent fibers. But unlike the former two divisions, the mandibular also contains motor or efferent fibers to the muscles of mastication, the mylohyoid and anterior digastric muscles, and the tensor veli palatini and tensor tympani muscles. So intimately associated with dentistry, the mandibular nerve has also been termed the dental nerve by anatomists in the past. This extensive and complicated division of the trigeminal nerve can cause confusion to both patient and doctor. Pain is often referred within its branches and even into other trigeminal divisions, chiefly the maxillary. This fourth and last article about the trigeminal nerve will present in detail the mandibular division.

Branchial Region↗
PubMed2002

Management of patients with trigeminal nerve injuries after mandibular implant placement.

BACKGROUND: Placement of mandibular endosseous implants can result in damage to the lingual nerve, the inferior alveolar nerve or both nerves. All dentists who place mandibular implants should be aware of the appropriate early management of these injuries, as well as the appropriate time to refer patients with these injuries to a microneurosurgeon. OVERVIEW: The lingual nerve is less likely to undergo spontaneous regeneration than is the inferior alveolar nerve, which is protected within the inferior alveolar canal. Since the inferior alveolar canal can be seen on most panoramic radiographs and on all high-quality computed tomographic scans, it is easier to avoid damage to the inferior nerve than to the lingual nerve, which is not visualized on radiographs and whose relationship to the posterior portion of the mandible varies from person to person. RESULTS: The authors reviewed one study that showed that lingual nerve repair helped 90 percent of patients. A second study found that patients who underwent lingual nerve repair reported a mean score of 7 on a scale from 0 to 10 in regard to the postoperative return of nerve function. Several other studies reported favorable patient responses to inferior alveolar nerve repair. CONCLUSIONS AND CLINICAL IMPLICATIONS: These results reinforce the need for early referral and intervention when inferior alveolar nerve injuries occur. Failure to refer patients with trigeminal nerve injury before distal nerve degeneration develops prevents minimization of the injury through microneurosurgical repair.

Dental Implantation, Endosseous↗
PubMed2003

Submandibular gland I: an anatomic evaluation and surgical approach to submandibular gland resection for facial rejuvenation.

Submandibular gland resection for aesthetic reasons has been hotly debated. Detractors maintain that the procedure is dangerous because it puts too many important structures at risk, notably motor nerves. The present study was undertaken to elucidate the neurovascular and soft-tissue anatomy of the digastric triangle via cadaver dissections so that a surgical approach to achieve safe aesthetic submandibular resection could be performed. Fifteen digastric triangles dissections were performed in fixed and fresh cadaver specimens. The dissection focus was to understand the submandibular neurovascular relationships, capsule as well as fascial layers, and measurements to known structures. The marginal mandibular nerve is located external to the submandibular capsule, approximately 3.7 cm cephalad to the inferior margin of the gland. The hypoglossal nerve is posterior to the digastric sling in a position that is protected deep within the visceral layer of the neck. The lingual nerve is located underneath the mandibular border, crossing anterior to the submandibular duct. The vascular supply is variant, but with an average of one and a half vessels entering medially to the superficial lobe of the gland, one intermediate vessel entering medially to supply the superficial and deep lobes, and one deep perforator that runs from the central portion of the deep lobe to the superficial lobe. Appreciation of this anatomy is critical in the submental approach for partial resection. Although it can be technically challenging, the anatomy is straightforward and partial submandibular gland resection can be executed via a consistent, safe approach to optimize facial rejuvenation in certain patients.

Cadaver↗
PubMed1981

Functional and structural studies concerning the control of activity in zygomatic glands of cats.

The zygomatic gland of the cat consists of at least two parts, separated by a septum, and each drains by a separate duct opening on a mucosal ridge postero-medial to the parotid orifice. It is composed on thin-walled ducts and tubulo-acini, containing mainly mucous cells, but scattered cap cells are also present. In cats under chloralose anaesthesia there is a spontaneous flow of extremely viscous saliva and often, in addition, there is a reflexly elicited component to the secretion. In fact, in contrast to the other major salivary glands, the zygomatic gland is easily made to secrete reflexly even in deep] anaesthesia, e.g. by pinching ipsilateral parts of the tongue, by stimulation of the oesophagus mimicking swallowing, or by afferent excitation of ipsilateral lingual, glossopharyngeal or vagal nerves. The efferent link of the reflex arc is contained in the buccal branch of the mandibular nerve. Section of this nerve abolishes these reflexes, and two weeks later a great loss of acetylcholinesterase positive nerves can be demonstrated in the gland. Efferent stimulation of the buccal nerve evokes a lively secretion that is not affected by hexamethonium but is abolished by atropine. Histochemically, adrenergic nerves are also found surrounding the acini and these nerves disappear after excision of the superior cervical ganglion. Electrical stimulation of the cervical sympathetic trunk causes some secretion, mainly by way of beta 1-adrenoreceptors. Myoepithelial cells are present around the tubulo-acini, and indications of the effect caused by their contraction on the flow from the glands have been observed. Such activity can be induced reflexly and it is then abolished by cutting the buccal nerve or by injecting atropine.

Acetylcholinesterase↗
PubMed2003

Subacute mandibular and hypoglossal nerve denervation causing oedema of the masticator space and tongue.

We report the MRI of five patients with denervation oedema in the head and neck. Four had denervation oedema in one masticator space caused by a skull-base tumour invading the ipsilateral foramen ovale. Another case had denervation oedema confined to the half of the tongue ipsilateral to oral reconstruction surgery which involved mandibulectomy, free flap repair and wide excision of a buccal mucosal carcinoma. Inversion-recovery and/or T2-weighted spin-echo images showed increased signal in the affected areas. Contrast-enhanced T1-weighted images revealed enhancement of the muscles. There was no evidence of tumour or infection in the masticator space or tongue. It is important to differentiate denervation oedema from other disease processes causing high signal on T2-weighted images, such as tumour infiltration and soft-tissue infection.

Adult↗
PubMed2001

Plate fixation of extra-oral subcondylar ramus osteotomy for correction of mandibular prognathism: clinical aspects and short term stability.

AIM: The present study describes an extra-oral approach for subcondylar oblique ramus osteotomy using stable fixation for setback of the mandible. The aim was to investigate the incidence of neurosensory disturbances of the mandibular nerve, evaluate facial scar appearance, and assess skeletal stability following the procedure. METHODS: Forty-two consecutive patients with mandibular prognathism were operated upon using the subcondylar oblique ramus osteotomy and plate fixation. The patients were followed up for 6 months following surgery. Intra-operative and postoperative complications, neurosensory function, and facial scar characteristics were recorded. Lateral cephalograms were available immediately before operation, and immediately after operation and 6 months postoperatively. Skeletal stability was based on cephalometric assessment. RESULTS: Among the 19 patients operated earliest, neurosensory disturbances were recorded in five individuals at the 6 month follow-up. In the subsequent group of 23 patients, no disturbances were reported. All but two patients were not concerned about the facial scar 6 months postoperatively. Mean anterior relapse at the 6 month follow-up was 0.5 mm, representing 9% of the surgical setback. CONCLUSION: Extra-oral subcondylar oblique ramus osteotomy with plate fixation is a stable procedure with a low incidence of neurosensory disturbances if the osteotomy is placed well behind the mandibular foramen. Facial scar appearance was rarely a matter of concern to the patients.

Adult↗
PubMed2001

[Effectiveness of Saiko-Keishi-To (TJ-10, a Kampo herbal medicine) for trigeminal neuralgia in rats].

It is known that Saiko-Keishi-To (TJ-10), a Kampo herbal medicine used for the treatment of epilepsy, shows a satisfactory curative effect even in the patients suffering from trigeminal neuralgia. To verify the effectiveness of TJ-10, Wistar rats with chronic neuralgia of the mandibular nerve were prepared and TJ-10 was administered to them for 4 weeks following the manifestation of pain in the mandibular region. The result reveals that the rise in the pain threshold in the mandibular region is more significant in the rats administered TJ-10 than in those in the control group. However, in the tail flick test, no significant change was observed in the pain threshold. These findings suggest that TJ-10 is effective for controlling the manifestation of pain in ligatured nerves, by local effect, not by general analgesic effect.

Analgesics↗
PubMed1981

The surgical anatomy of the mandibular distribution of the facial nerve.

There are many controversies about the course of the mandibular nerve in the submandibular region. In an attempt to resolve these and improve the safety of submandibular approaches a study was undertaken based on anatomical dissection and measurement of 110 facial halves. In over half the specimens the mandibular nerves ran below the mandible and a significant proportion continued below the mandible distal to the facial vessels. The nerves lay in a plane between the platysma and the investing fascia. These findings influence the placement and depth of incisions in the submandibular region and the margins of safety attainable.

Aged↗
PubMed2003

Parotid surgery using Nd:YAG laser contact tips: clinical assessment of perioperative facial nerve function.

OBJECTIVE: The objective of this paper is to review 51 consecutive contact Nd:YAG laser parotidectomies to determine perioperative outcomes and complications related to the facial nerve and the use of the laser tips. BACKGROUND DATA: Parotid surgery is mostly performed with scalpel or scissors, techniques that may put the facial nerve at risk for injury due to brisk bleeding and imprecise dissection. Even though previous experiences with Nd:YAG lasers in surgery had raised concerns of energy dispersion, the contact sapphire tips used in this series allowed accurate precise dissection and hemostasis, limiting complications. MATERIALS AND METHODS: Close facial nerve dissection was done at 8-12 watts, for an average total of 8,000-12,000 joules per case. RESULTS: No significant or permanent facial nerve complications resulted from the use of the laser tips, except for expected transient and reversible postoperative ipsilateral marginal mandibular nerve paresis observed in 43% of the patients-less than the generally quoted 50% expected after uneventful lateral lobe parotidectomy. CONCLUSION: This review concludes that the contact Nd:YAG laser may offer significant technical and safety advantages, and no direct associated complications in the dissection and preservation of the facial nerve in parotidectomy.

Aged↗
PubMed1976

On the homology of the alisphenoid.

The relationships of the elements of the cavum epiptericum in a hypothetical primitive mammalian precursor are reconstructed, and these are analysed in relation to the development of recent mammals, especially the fruit bat Nyctinomus johorensis. The alisphenoid in mammals is part cartilage bone, part membrane bone. The mammalian homologue of the primitive reptilian processus ascendens appears to be internal to the maxillary nerve. If so, then the 'lamina ascendens', that portion of the alisphenoid of mammals which lies between maxillary and mandibular nerves, cannot be a true processus ascendens but must be neomorphic. It is suggested that the mammalian lamina ascendens arose from an upgrowth of the root of the quadrate ramus of the epipterygoid in cynodonts, separating foramen rotundum from foramen ovale. In Ditremata the alisphenoid is completed by an element of membrane bone; this, it is suggested here, originated as the anterior lamina of the periotic in cynodonts, which is retained in monotremes. It is suggested that the alicochlear commissure of mammals originated as the later flange of the periotic in cynodonts.

Animals↗
PubMed2004

The position of the inferior alveolar nerve at the mandibular angle:: an anatomic consideration for aesthetic mandibular angle reduction.

Mandibular angle reduction is a popular contouring surgery in Asia. Avoidance of injury to the inferior alveolar nerve is crucial during these procedures. Anatomic data regarding the position of the nerve in the mandibular angle area are sparse. The purpose of this study was to use 3-dimensional computed tomographic data to evaluate the nerve in patients with prominent mandibular angles and to compare the nerve position with a normative group. A total of 28 female and 5 male adult patients who presented with a complaint of prominent angles or a "square-face" look, as well as 20 female and 22 male adult normal subjects were included, for a total of 150 hemimandibles for extraction of the inferior alveolar nerve. The nerve and the mandible were displayed. Point O was defined on the oblique line along the anterior cortex of ramus, where it intersected with a line extending from the alveolar arch. From the O point, linear distances were defined, including horizontal distances to the posterior cortex, oblique distances to the gonion, and the vertical distances to the inferior cortex. Mandibular width was defined as the distance between the 2 gonion points. Results demonstrated significant differences mainly in the oblique distances (ie, from the O point to the nerve [O1], from the nerve to the gonion [O2], and from the O point to the gonion [O1-O2]) in both female and male patients. The O2 distance was 23.69 mm versus 20.66 mm in women and 27.30 mm versus 23.28 mm in men (square face vs norm). The mandibular width was significantly larger in the male square-face patients, but the difference was not significant between the female groups. These results provide useful information for surgeons planning mandibular angle reduction. These findings suggest that the mandibular contouring procedure should be aimed at correcting regional osseous dysmorphology in the angle area and improving the relationship to the chin, rather than merely reducing the mandibular width.

Adult↗
PubMedDate not supplied

[Use of transcutaneous electroneurostimulation for enhancing the effectiveness of conduction anesthesia in dental polyclinic practice].

The efficiency of mandibular conduction anesthesia was assessed in patients with inflammatory disorders in the area innervated by the mandibular nerve. In patients with conduction anesthesia induced after an electroneurostimulation session, the efficiency of anesthesia was considerably higher than in those operated on under mandibular anesthesia only.

Adolescent↗
PubMed2004

Endoscopic vertical ramus osteotomy: early clinical results.

PURPOSE: The benefits of minimally invasive surgery have been well documented. The purpose of this report was to present early results in a series of patients who had endoscopic mandibular orthognathic surgery. Patients and methods This is a retrospective evaluation of 14 patients who underwent endoscopic vertical ramus osteotomy and rigid fixation for the treatment of mandibular prognathism (n = 9), malocclusion secondary to trauma (n = 3), or other pathology (n = 2). A 1.5-cm incision was made directly below the mandibular angle. The dissection was continued bluntly to the masseter muscle, which was incised using a needlepoint electrocautery. Then, with endoscopic elevators, an optical cavity was created for insertion of a Hopkins endoscope and visualization of the ramus/condyle unit. Anatomic landmarks were identified and the operation carried out with specially designed endoscopic equipment. Preoperative (T0), postoperative (T1), and follow-up (T2) clinical examinations; lateral cephalograms; and panoramic radiographs were used to evaluate the outcomes. RESULTS: The procedures performed included: vertical ramus osteotomy (n = 13 patients, 23 sides) and condylectomy plus vertical ramus osteotomy (n = 1 patient, 1 side). Mean operating time was 37 minutes per side. One patient had temporary marginal mandibular nerve weakness. The occlusal result was as planned in all cases. Panoramic radiographs documented postoperative ramus/condyle unit position and lateral cephalograms documented mandibular position. CONCLUSIONS: The results of this case series indicate that endoscopic vertical ramus osteotomy with rigid fixation is feasible for correction of a variety of mandibular deformities.

Adolescent↗