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Mandibular nerve dental surgery

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Ophthalmic nerve dental surgery Maxillary nerve Mandibular nerve

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Mandibular nerve dental surgery

  1. 1.    Largest of the three divisions of the fifth. Made up of two roots: A large - sensory root proceeding from the inferior angle of the semilunar ganglion. A small motor root which passes beneath the ganglion - unites with the sensory root - just after its exit - foramen ovale. Immediately beneath the base of the skull - gives off a recurrent branch (nervus spinosus) and the nerve to the Pterygoideus internus - then divides into two trunks - an anterior and a posterior.
  2. 2.  SUPPLIES – Teeth and gums of the mandible, 2. The skin of the temporal region 3. The auricle. 4. The lower lip. 5. The lower part of the face. 6. The muscles of mastication , 7. It also supplies the mucous membrane of the anterior twothirds of the tongue. 1.
  3. 3. A. Main trunk  Medial pterygoid  Nervus spinosus (meningeal branch)  Nerve to tensor veli palatine.  Nerve to tensor tympani B. Anterior division Messetric  External Pterygoid  Deep Temporal  Buccinators C. Posterior division. Auriculotemoral  Lingual  Inferior alveolar.
  4. 4.  Nerve to Medial pterygoid  Nervus spinosus (meningeal branch)- enters the skull through foramen spinosum. Supplies duramatter of middle cranial fossa.  Nerve to tensor veli palatine.  Nerve to tensor tympani
  5. 5.    The anterior and smaller division of the Mandibular nerve receives nearly the whole of the fibers of the motor root of the nerve. Supplies - Muscles of mastication - Skin and mucous membrane of the cheek Its branches are Messetric Deep temporal Buccal nerve (sensory) External pterygoid.
  6. 6. MESSETRIC NERVE:  Arises from the upper border of lateral pterygoid muscle.  Passes through Mandibular notch.  Enters the deep part of messeter.  Also supplies TMJ (temporomandibular joint). BUCCAL NERVE:  Only sensory branch from anterior division.  Passes btn 2 heads of lateral pterygoid.  Supplies skin and mucous membrane related to Buccinator. DEEP TEMORAL:  2 Nerve anterior and posterior.  Passes btn skull and lateral pterygoid.  Enters the deep surface of temporalis muscle. EXTERNAL PTERYGOID NERVE:  Arises in conjunction with the Buccinator nerve.  But may be given off separately from the anterior division of the Mandibular nerve.  It enters the deep surface of the muscle. .
  7. 7.  The posterior and larger division of the Mandibular nerve - sensory but receives a few filaments from the motor root.  It divides into Auriculotemoral Lingual Inferior alveolar nerves
  8. 8.  Arises by two roots – b/w which the middle meningeal artery ascends.  Runs backward beneath to the medial side of the neck of the mandible.  Then turns upward with the superficial temporal artery b/w the auricula and condyle of the mandible.  It ascends over Zygomatic arch - divides into superficial temporal branches.
  9. 9. BRANCGES OF DISTRIBUTION:  Anterior auricular branches  Branches to the external acoustic meatus  Articular branches  Parotid branches  Superficial temporal branches.
  10. 10. Supplies - mucous membrane of the anterior two-thirds of the tongue.  Lies at first beneath the lateral Pterygoid - medial to and in front of the inferior alveolar nerve.   The nerve then passes b/w the medial Pterygoideus and the ramus of the mandible - then between the Hyoglossus and deep part of the submaxillary gland.  Finally runs across the duct of the submaxillary gland and along the tongue to its tip.
  11. 11. BRANCHES OF DISTRIBUTION:  Supply - sublingual gland - mucous membrane of the mouth, the gums, and the anterior two-thirds of the tongue.  The terminal filaments communicate - at the tip of the tongue with the hypoglossal nerve.
  12. 12.  Largest branch of the Mandibular nerve.  Descends with the inferior alveolar artery - at first beneath the lateral Pterygoid - then b/w the sphenomandibular ligament and the ramus of the mandible to the Mandibular foramen.  Then passes forward in the Mandibular canal - beneath the teeth as far as the mental foramen - where it divides into two terminal branches - incisive and mental.  Branches of the inferior alveolar nerve are the Mylohyoid Dental Incisive Mental.
  13. 13. MYLOHYOID NERVE:  Derived - inferior alveolar just before it enters the mandibular foramen.  It descends - groove on the deep surface of the ramus of the mandible - reaching the under surface of the Mylohyoid supplies this muscle and the anterior belly of the Digastric. DENTAL BRANCHES:  Supply - molar and premolar teeth  Above the alveolar nerve they form an inferior dental plexus.
  14. 14. INCISIVE BRANCH:  Continued onward within the bone and supplies the canine and incisor teeth. MENTAL NERVE:  Emerges at the mental foramen - divides beneath the Triangularis muscle into three branches. One descends to the skin of the chin. Two ascend to the skin and mucous membrane of the lower lip. these branches communicate freely with the facial nerve.
  15. 15. OTIC GANGLION –  Peripheral parasympathetic ganglion  Relay secret motor fibers to parotid gland.  Topographically related to Mandibular nerve but functionally related to glossopharyngeal nerve.
  16. 16.  Motor part of the nerve is tested by asking the patient to clench his teeth.- look for contraction of messeter muscle.  In case of the cancer of the tongue, pain radiates to ear and temporal fossa due to Auriculotemoral nerve.  Trigeminal neuralgia commonly seen with Mandibular branch can be treated by cutting the sensory root.
  17. 17. Thank You

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