Variations in the anatomy of the inferior alveolar nerve

Variant Inferior Alveolar Nerves and Implications for Local Anesthesia

“…If anatomical variations manifest as neuralgias, appropriate follow-up and referrals will be required to manage the patient's specific complaint. 37,61 In conclusion, an understanding of anatomical variations is imperative, as without adopting alternate anesthesia techniques such variations may potentially thwart a clinician from achieving successful pain control. In addition, by performing thorough diagnostic and presurgical evaluations of the associated neurovasculature, clinicians will not only be better able to assess any anatomical variants present, but also be able to better influence outcomes of surgical procedures related to the infratemporal fossa or mandible.…”

“…Specifically, the inferior alveolar nerve is known to bifurcate high in the infratemporal fossa and travel to the base of the coronoid process to then enter the mandible through accessory foramina in the retromolar region (Figure 4a). 6,[35][36][37][38] The presence of bifid inferior alveolar nerves may complicate dental anesthesia procedures because routine techniques for inferior alveolar nerve block, such as the Halstead method, 39 may be insufficient to effectively block nerve conduction through both branches of the bifid nerve. 40,41 The inferior alveolar nerve can enter the mandibular foramen as a single branch with variations within the mandible, 42 and may also pose complications to obtaining profound anesthesia (Figure 4c, d, e).…”

“…Additional reports have shown the maxillary artery being enclosed within the inferior alveolar nerve and the presence of a connecting nerve to the auriculotemporal nerve, or located between the inferior alveolar nerve and the lingual nerve. 37,46 The presence of the maxillary artery enclosed between nervous structures can have several clinical implications. The associated nerves can be compressed by pulsations of the artery, resulting in symptoms such as pain and numbness.…”

Numbness of the ear following inferior alveolar nerve block: the forgotten complication

“…15 This, in addition to the presence of a connecting nerve branch with the inferior alveolar nerves, is a possible reason for achieving anaesthesia in the area supplied by the auriculotemporal nerve when a standard inferior alveolar nerve block is given. 15,16 There is also a possibility that the local anaesthetic agent spread via the masticatory fascial space through which run the inferior and lingual nerves. This fascial space communicates with the pterygoid fascial, which contains the auriculotemporal nerve and portions of the ptyergoid plexus, thus the anaesthetic may have got to a higher location than was intended.…”

Variaciones del Canal Mandibular con Importancia Clínica: Reporte de Caso

“…Las variaciones del canal así como de su contenido; nervio mandibular y sus ramas, y los vasos mandibulares han sido reportadas como la posible causa de una inadecuada técnica anestésica; iatrogénia y complicaciones asociadas (Anil et al, 2003;Beltrán et al, 2011), además de complicaciones tales como compresión neurovascular causando entumecimiento y/o dolor. Razón que nos ha llevado a describir el presente caso clínico de un canal mental accesorio, acompañado de bucle anterior del nervio mental de ubicación bilateral.…”