Mandibular nerve- Anatomy,Functional components Course & distribution, Branches of the nerve, Ganglia associated.Periodontal considerations and applied clinical aspects.

1. MANDIBULAR NERVE
PRESENTEDBY:
DR. THASLIMFATHIMA
FIRSTYEARPOSTGRADUATE
DEPARTMENTOFPERIODONTOLOGY
RRDCH

2. CONTENTS:
• INTRODUCTION
• NUCLEI
• FUNCTIONAL COMPONENTS-SENSORY AND MOTOR
ROOT
• COURSE & DISTRIBUTION
• BRANCHES OF THE NERVE
• GANGLIA ASSOCIATED
• PERIODONTAL CONSIDERATIONS
• APPLIED CLINICAL ASPECTS
• CONCLUSION
• REFERENCES

3. INTRODUCTION
Mandibular nerve is the largest branch of the
trigeminal nerve.
The trigeminal nerve is the largest cranial nerve.
It is the nerve of the first branchial arch.
OPHTHALMIC
MAXILLARY
MANDIBULAR

4. • The trigeminal nerve is composed of a smaller motor
root and a large (tripartite) sensory root.
• Supplies-
• the muscles of mastication and
• other muscles in the region.
Motor root
• Supplies-
• the skin of the entire face
• the mucous membrane of the cranial
viscera and the oral cavity,except for
the base of the tongue and pharynx
Sensory root

5. NUCLEI
GENERAL SOMATIC AFFERENT COLUMN
1.Spinal nucleus
fibers conveying pain and
temperature sensations from
most of the face area relay here.
2.Superior sensory nucleus
fibers carrying touch and
pressure sensations relay in
this nucleus.
3.Mesencephalic nucleus
this nucleus extends in the midbrain .
It receives proprioceptive impulses

6. BRANCHIAL EFFERENT COLUMN
• Special visceral efferent fibers innervate the muscles of
mastication, tensor tympani, tensor veli palatini, muscles
of the eye and facial muscles.
• The nucleus of the trigeminal nerve is situated at the
level of upper pons
• Afferent fibers constitute the sensory root(portio major)
• Efferent fibers form the smaller motor root(portio minor)

7. MOTOR ROOT
– The motor root originates in the motor nucleus within the pons and
medulla oblongata.
– Its fibers,forming a small nerve root,
travel anteriorly along with,but
entirely separate from the larger
sensory root to the region of the
semilunar (gasserian) ganglion.
– At the semilunar ganglion,the motor root passes in a lateral and inferior
direction under the ganglion toward the foramen ovale,through which it
leaves the middle cranial fossa along with the 3rd division of the sensory
root,the mandibular nerve.

8. • Just after leaving the skull, the motor root unites with the
sensory root of the mandibular divison to form a single
nerve trunk.
• Motor fibres of the trigeminal nerve supply the following
muscles:
1. Masticatory- Masseter-Temporalis-Lateral pterygoid-
Medial pterygoid
2. Mylohyoid
3. Anterior belly of the digastric
4. Tensor tympani
5. Tensor veli palatini

9. SENSORY ROOT
• Sensory root fibres of the trigeminal nerve comprise the central
processes of ganglion cells located in the trigeminal
(semilunar/gasserian) ganglion.
• There are two ganglia; one innervating each side of the face.
• They are located in Meckel’s cave,
on anterior surface of petrous temporal area.
• Ganglia are flat and crescent shaped,
their convexities facing anteriorly and
downwards; they measure 1.0 x 2.0 cm.

10. Sensory root fibres enter the concave portion of each
crescent and the three sensory divisions of the trigeminal
nerve exit from the convexity.
i) Ophthalmic Nerve: It travels anteriorly in lateral wall of the cavernous sinus to
the medial part of the superior orbital fissure ,through which it exits the skull into
the orbit.
ii) Maxillary Division: It travels anteriorly and downwards to exit cranium
,through foramen rotundum into upper portion of pterygopalatine fossa.
iii) Mandibular division : It travels almost directly downwards to exit the skull,
along with the motor root, through foramen ovale.These two roots then
intermingle , forming one nerve trunk , and then enter the infratemporal fossa.

11. Ophthalmic division-
carries sensory fibers
from structures
derived from
frontonasal process.
Maxillary division-
carries afferent fibers
from structures
derived from
maxillary process.
Mandibular division –
carries sensory fibers
derived from
mandibular process

12. AREAS INNERVATED BY THE
MANDIBULAR NERVE
SKIN OF: Temporal region
Auricula
External auditory meatus
Cheek
Lower lip
Lower part of the face(chin region)
MUCOUS MEMBRANE OF:
cheek and anterior 2/3rd of tongue
Mandibular teeth & periodontal tissues,
Bone of the mandible
TMJ
Parotid gland
SENSORY

13. AREAS INNERVATED BY THE
MANDIBULAR NERVE
MOTOR
ROOT
Masticatory
muscles
Mylohyoid
Anterior
belly of
digastric
Tensor
tympani
Tensor veli
palatini

14. Mandibular Nerve
• COURSE
• The two roots emerge from the cranium separately
through the foramen ovale,the motor root lying medial to
the sensory.
• They unite just outside the skull & form the main trunk of
the third division.
• The trunk remains undivided for only 2 to 3 mm before it
splits into small anterior and large posterior division.

15. Branches Of The Mandibular Nerve
DIVIDED
NERVE
UNDIVIDED
NERVE
POSTERIOR
DIVISION
ANTERIOR
DIVISION
NERVE TO MEDIAL
PTERYGOID
NERVUS
SPINOSUS

16. Anterior division
Lateral pterygoid
Masseter
Temporal
Buccal
Posterior division
Auriculotemporal
Lingual
Mylohyoid
Inferior alveolar
Incisive
Mental

18. BRANCHES FROM THE UNDIVIDED
NERVE:
1.Nervus spinosus:
• It re enters the cranium through the foramen spinosum
along with the middle meningeal artery to supply the
dura mater and mastoid air cells.
2. Medial pterygoid nerve:
• It is a motor nerve to the medial pterygoid muscle. It
gives off small branches to the tensor veli palatini and
tensor tympani.

19. BRANCHES FROM THE DIVIDED NERVE
ANTERIOR DIVISION
1. Buccal nerve:
• It is the only sensory branch of the anterior division.
• It passes between the two heads of the lateral pterygoid, and
runs downwards and forwards to supply:
-skin of the cheek
-Buccal gingiva of the mandibular
molars and the muccobuccal fold in
that region.

20. • Anesthesia of the buccal nerve is important for dental
procedures requiring soft tissue manipulation on the buccal
surface of the mandibular molars.
• The long buccal nerve block should be administered
immediately following inferior alveolar nerve block.

21. 2. Masseteric Nerve
• Emerges at the upper border of the lateral pterygoid just
in front of the TMJ
• Passes laterally through the mandibular notch in
company with the masseteric vessls,and enters the deep
surface of the masseter.
• It also supplies the TMJ.

22. 3. Deep Temporal Nerve
• Deep temporal nerves are two nerves,anterior and posterior.
• They pass between the skull and the lateral pterygoid,and enter
the deep surface of the temporalis.
4. Nerve to Lateral Pterygoid
• Enters the deep surface of the lateral pterygoid muscle and
provides motor innervation.

23. POSTERIOR DIVISION:
1. AURICULOTEMPORAL NERVE
• It traverses the upper part of the parotid gland and
then crosses the posterior portion of the zygomatic
arch.

24. • It gives off a number of branches which are sensory.These
include:
1. A communication with the facial nerve,providing sensory
fibers to the skin over the areas of innervation of the
zygomatic,buccal and mandibular branch of facial nerve.
2. A communication with the otic ganglion,providing
sensory,secretory and vasomotor fibres to the parotid gland.

25. 3. The anterior auricular branches,supplying the skin
over the helix and tragus of the ear.
4. Branches to the external auditory meatus,innervating
the skin over the meatus and the tympanic membrane.
5. Articular branches to the posterior portion of the TMJ.
6. The superficial temporal branches,supplying the skin
over the temporal region.

26. LINGUAL NERVE
• It is the second branch of the posterior division of
mandibular nerve.
• It is sensory to:
• However the fibres of chorda tympani(which is
secretomotor to the sub mandibular and sublingual
salivary glands and gustatory to anterior two thirds of the
tongue),are also distributed through the lingual nerve.

27. RELATIONS:
• It begins 1cm below the skull
• It runs between the tensor veli palatine and
lateral pterygoid
• And then between the lateral and medial
pterygoids.
• About 2cms below the skull,it is joined by the
chorda tympani nerve.
• Emerging at the lower border of the lateral
pterygoid,the nerve runs downwards and
forwards between the ramus of the mandible
and the medial pterygoid.
• Next,it lies in direct contact with the
mandible,medial to the 3rd molar
tooth,between the origins of the superior
constrictor and the mylohyoid muscles.
• It soon leaves the gum and runs over the
hyoglossus deep to the mylohyoid
• Finally,it lies on the surface of the
genioglossus deep to the mylohyoid.
• Here it winds around the submandibular duct
and divides into its terminal branches

29. INFERIOR ALVEOLAR NERVE
It is the largest branch of the
posterior division of the mandibular
nerve.
It descends,medial to the lateral pterygoid muscle and
lateroposterior to the lingual nerve,to the region between
the sphenomandibular ligament and the medial surface of
the ramus,where it enters the mandibular canal at the level
of the mandibular foramen.

30. • Throughout its path in the mandibular canal,it is
accompanied by the inferior alveolar artery and the
inferior alveolar vein.
• The nerve,artery and the vein travel anteriorly in the
mandibular canal as far forward as the mental
foramen,where the nerve divides into terminal branches:
The incisive nerve
The mental nerve

31. • Bifid inferior alveolar nerves and mandibular canals have
been observed radiographically and categorized by
Langlais et al.*
• In 6000 panoramic radiographs studied,bifid mandibular
canals were evident in 0.95%.
CLINICAL SIGNIFICANCE:
Difficulty of achieving adequate anesthesia in the mandible
with conventional techniques.
Especially in the Type 4 variation.
*Langlais RP et al,Bifid mandibular canals in panoramic radiographs,J Am Dent
Assoc 110:923-926

33. Normal
radiographic
appearance of the
inferior alveolar
nerve.
Bifid IAN.

34. MYLOHYOID NERVE
• The mylohyoid nerve branches from the IAN prior to the
latter’s entry into the mandibular canal.
• It runs downward and forward in the mylohyoid groove
on the medial surface of the ramus and along the body
of the mandible to reach the mylohyoid muscle.
• The mylohyoid nerve is a mixed nerve,being motor to the
mylohyoid muscle and the anterior belly of digastric.
• Sensory innervation to the mandibular incisors

35. • The dental plexus serves the mandibular posterior
teeth,entering through their apices and providing pulpal
innervation.
• Other fibers supply sensory
innervation to the buccal
periodontal tissues of these
same teeth.
• At the mental foramen,the IAN
divides into two terminal branches:
the incisive nerve and the mental nerve.

36. MENTAL NERVE
• The mental nerve exits the canal through the mental
foramen and divides into 3 branches that innervate the
skin of the chin and the skin and mucous membrane of
the lower lip.

37. INCISIVE NERVE
• The incisive nerve remains within the mandibular canal and
forms a nerve plexus that innervates the pulpal tissues of the
mandibular 1st pre molar,canine, and incisors via the dental
branches.
• It supplies the labial aspect of gums of canine and incisor
teeth.

38. GANGLIA ASSOCIATED WITH THE
MANDIBULAR DIVISION
• Submandibular ganglion
• Otic ganglion
SUBMANDIBULAR GANGLION:
• This is a parasympathetic peripheral ganglion.
• It is a relay station for secretomotor fibers to the
submandibular and sublingual salivary glands.
• Topographically- Lingual nerve
• Functionally- Chorda tympani

39. • LOCATION:
• The fusiform ganglion lies on the hyoglossus muscle
just above the deep part of the submandibular
salivary gland, suspended from the lingual nerve by
two roots.

40. CONNECTIONS AND BRANCHES
The secretomotor fibers pass from the lingual nerve to the
ganglion through the posterior root.
superior salivatory nucleus
nervus intermedius
facial nerve
chorda tympani
joins lingual nerve
submandibular ganglion
relay
post ganglionic branches
submandibular and sublingual gland

41. • Sympathetic fibers are derived
from the plexus around the facial
artery.
• It contains post ganglionic fibers
arising in the superior cervical
ganglion.
• They pass through
submandibular ganglion without
relay, and supply vasomotor
fibers to the submandibular and
sublingual glands.
• Sensory fibers reach the
ganglion through the lingual
nerve

42. OTIC GANGLION
• It is a peripheral para sympathetic ganglion which
relays secreto-motor fibres to the parotid gland.
• Topographically- mandibular nerve
• Functionally- glossopharyngeal nerve
• SIZE AND SITUATION:
• It is 2-3mm in size and is situated in the
infratemporal fossa, just below the foramen ovale.
• It lies medial to the mandibular nerve and lateral to
the tensor veli palatini. It surrounds the origin of the
nerve to the medial pterygoid.

43. CONNECTIONS AND BRANCHES:
1. The motor or parasympathetic root is formed by the
lesser petrosal nerve.
Secretomotor root
Parotid gland
Join auriculotemporal nerve
Postganglionic fibres
OTIC GANGLION
Lesser petrosal nerve
Tympanic plexus
Tympanic branch
IX nerve
Preganglionic fibres from the inferior salivatory nucleus

44. 2.The sympathetic root is derived from the plexus on the
middle meningeal artery.
• It contains postganglionic fibers arising in the superior
cervical ganglion.
• The fibers pass through the otic ganglion without relay and
reach the parotid gland via auriculotemporal nerve.
• They are vasomotor in function.

45. • 3. The sensory root comes from the auriculotemporal
nerve and is sensory to the parotid gland.

46. • Other fibers passing through ganglion are:
• 1.Nerve to medial pterygoid – gives a motor root to
the ganglion and supplies the tensor veli palatini and
tensor tympani muscles.
• 2. Chorda tympani nerve- provide an alternative
pathway of taste from anterior two thirds of tongue.

47. PERIODONTAL CONSIDERATIONS
• Nerves to gingiva run in the tissue superficial to the
periosteum.

48. MENTAL NERVE-INCISIVE NERVE
• The gingiva associated with labial side of the incisiors,canine
and the premolar teeth is innervated by the mental branch of
inferior alveolar nerve.

49. IAN-BUCCAL NERVE
• The buccal gingiva of the molars and second premolar is
innervated by the buccal nerve of the inferior alveolar
nerve.

50. LINGUAL
• The lingual gingiva is innervated by sublingual nerve(end
branch of lingual nerve)

51. APPLIED CLINICAL ASPECTS

52. APPLIED CLINICAL ASPECTS
1. In operations on the TMJ,the facial nerve and
auriculotemporal nerve,(branch of mandibular division of
trigeminal nerve) should be preserved with care.
2. The motor part of the mandibular nerve is tested clinically
by asking the patient to clench his/her teeth and then feeling
for the contracting masseter and temporalis muscle on the
two sides.
• If one masseter is paralysed, the jaw deviates to the
paralysed side, on opening the mouth by the action of normal
lateral pterygoid muscle of the opposite side.
• The activity of pterygoid muscles is tested by asking the
patient to move the chin from side to side.

53. APPLIED CLINICAL ASPECTS
3. Referred pain: In cases with the cancer of tongue , pain
radiates to the ear and to temporal fossa, over the distribution
of the auriculotemporal nerve as both lingual and
auriculotemporal nerve are branches of V3.
Sometimes the lingual nerve is divided to relieve intractable
pain of this kind.
This maybe done where the nerve lies in contact with the
mandible below and behind the last molar tooth,covered only
by mucous membrane.

54. APPLIED CLINICAL ASPECTS
• 4.Mandibular neuralgia: Trigeminal neuralgia of the
mandibular division is often difficult to treat. In such
cases, the sensory root of the nerve may be divided
behind the ganglion, and this is now the operation of
choice when pain is confined to the distribution of the
maxillary and mandibular nerves.

55. APPLIED CLINICAL ASPECTS
• 5. Since the mandibular nerve innervates a portion of the
external ear and the lower teeth,the pain of lower teeth
may be referred to the ear.
• 6. Loss of jaw-jerk reflex: Any lesion of the foramen
ovale leads to paraesthesia along the mandible, tongue,
temporal region, and paralysis of the muscles of
mastication.

56. APPLIED CLINICAL ASPECTS
• 7. In extraction of the mandibular teeth,IAN needs to be
anaesthetised.
• The drug is given into the nerve before it enters the
mandibular canal.
MANDIBULAR ANESTHESIA TECHNIQUES:
Inferior alveolar
nerve block
Long buccal nerve
block
Lingual nerve
block
Mental nerve
block
Incisive nerve
block
Mandibular nerve
block-The Gow-
Gates Technique
Vazirani-Akinosi
closed mouth
mandibular block
Extra-oral
technique

57. APPLIED CLINICAL ASPECTS
8. As the IAN travels through the mandibular
canal,it can be damaged by the fracture of the
mandible.
• This injury can be assessed by testing sensation over
the chin.

58. APPLIED CLINICAL ASPECTS
• 9. SENSORY NERVE DAMAGE DURING
EXTRACTION OF LOWER THIRD MOLARS
• It has been reported in the IAN,lingual nerve and long
buccal nerve.
• A review of literature shows that nerve damage occurs
following 0.6% to 5% of third molar removals.

59. • Prevention of IAN injury:
• The relationship between the third molar and the nerve
can be determined from preoperative radiographs.
• It can be visualized on a panoramic radiograph.
• It is of consistent width and has a radiopaque cortical
outine visible superiorly and inferiorly.

60. • If the outline of the nerve is seen crossing the roots of
the third molar and the nerve canal retains its size and
cortical outine,the tooth is probably not intimately related
to the nerve.
Radiograph of IAN crossing the roots of a third molar,showing
no loss of cortical outline,narrowing,or deviation.Relationship
is probably one of superimposition only.

61. • If,however,the nerve loses its cortical outline,the nerve
canal is narrowed or displaced,there is a very initimate
relationship between the tooth and the nerve,which may
even perforate the tooth roots.

63. Factors associated with a higher instance of IAN
damage following wisdom tooth removal:
1. Full bony impactions
2. Horizontal impactions
3. Use of burs for removal
4. Apices extending into or below the level of
neurovascular bundle
5. Clinical observation of the bundle during surgery
6. Excessive haemorrhage into the socket during surgery
7. Age of the patient

64. • Once the assessment has been made,the tooth should
be removed in such a way as to minimize the risk.
• This will often involve sectioning of the tooth.

65. Lingual nerve damage: During improper extraction of third
molar or fracture of the angle of mandible , the lingual
nerve may get damaged in the floor of the mouth. This
results in loss of sensations from anterior two thirds of the
tongue.

66. • Lingual nerve injury occur in about 1% of lower third
molar removals.
• They often include abnormal taste sensation.
• Spontaneous recovery is less likely.
• In some cases,the lingual nerve may run over the
retromolar pad.Such a nerve maybe traumatized by flap-
raising and retraction techniques,by follicle removal,and
by suturing procedures.

67. • Developmental perforation of the lingual plate of the
mandible by the roots of the third molar tooth or other
pathology (cyst) in the approximate area where the
lingual nerve is closely adapted to the periosteum may
also explain some cases of lingual nerve damage.

68. • Variations in the surgical technique for 3rd molar removal
appear capable of decreasing the incidence of lingual
nerve damage.
• Flaps can be made from a more buccal approach to
avoid lingual nerve lying on the retromolar pad.

69. • If suturing is to be carried out postoperatively,sutures
should be placed superficially in the lingual flap to avoid
possible nerve trauma.
• The question of raising a lingual flap and using a lingual
retractor is more controversial.
• Placement of a lingual retractor is associated with a 13%
temporary paraesthesia rate but no permanent nerve
damage,the rate of permanent damage is around 2% if
no retractor is used.

70. • Most patients recover without treatment,as shown in
a definitive review by Alling,wherein over 96% of
patients with IAN injuries and 87% of those with
lingual nerve injuries recovered spontaneously.
• The higher incidence of IAN recovery is probably
due to the fact that the nerve is retained within a
bony canal and the damaged nerve endings are
better approximated spontaneously.

71. APPLIED CLINICAL ASPECTS
10. NERVE INJURY DURING IMPLANT PLACEMENT:
1.INFERIOR ALVEOLAR NERVE
Injury prevention
• Use of CT scan images to determine the exact distance
bewteen the superior border of the inferior alveolar canal
and the crestal bone at the planned implant site.
• Maintenance of a 2-mm margin of
safety between the apical end of the
implant and the superior border of the
inferior alveolar canal.

72. • Use of drill stoppers to prevent
overpenetration of the drill.
• Use of computer generated surgical
guide such as SurgiGuide
(Materialise) to place implants in the
safest and most accurate manner
possible.
• Compensation for the slight
additional length of the drill( the drills
for most implant systems are
approximately 0.5-1.0 mm longer
than the implant).

73. 2. Mental nerve:
• It is important for clinicians to be
aware of the anterior loop of the
mental nerve,which traverses
inferiorly and anteriorly to the
mental foramen before turning back
to exit the foramen.
• The nerve may be found anterior to
the mental foramen by as much as
3mm.
• If an implant is planned mesial and
inferior to the foramen,its most
posterior extent should be at least
5mm anterior to the mesial aspect
of the foramen.

74. Injury prevention:
• The pilot drill should penetrate crestal
bone 7-8mm anterior to the most mesial
aspect of the mental foramen to avoid
drill penetration through the anterior
loop(3mm anterior loop+2mm safety
zone+the implant radius).
• Flap-releasing incisions mesial to the
mental nerve should terminate just
superior to the mucogingival junction.

75. • In a mandible with extensive resorption,the mental
foramen may be located on the crest of the ridge.
• When that happens,the crestal incision should be placed
toward the lingual and the full-thickness flap carefully
reflected until the foramen is identified.
• In some situations,a flapless
insertion protocol should be
followed to avoid damaging
the mental nerve and its
branches.

76. 3. Mandibular incisive canal and nerve
• In some cases,the incisive nerve might present as a true canal
with large lumen (0.48 to 2.90 mm),extending anteriorly and
inferiorly from the mental foramen,usually 8-10 mm from the
lower border of the mandible.
• The incisive canal can not be detected clearly on conventional
radiographs; therefore, CT scans are recommended for proper
assessment.

77. 4. Lingual nerve
• The lingual nerve is typically located
immediately medial to the lingual
cortical plate of the mandible,below
the crest of the ridge and posterior to the 3rd molar roots.
• It is covered in this area by a thin layer of oral mucosa and
may be visble clinically.
• In a magnetic resonance study,Miloro and colleagues found
that the nerve crosses over the retromolar pad in 10% of
patients,leading to a higher risk of traumatization during flap
elevation,retraction, and suturing.

78. Injury prevention-Lingual nerve
• Transecting the lingual nerve will anesthetize the
tongue,decrease saliva flow from the submandibular
gland,and affect taste. This can be avoided by:
- Placement of the distal releasing incision at 30 degrees
toward the buccal in the retromolar pad.
- Careful and gentle reflection of the lingual flap in the
posterior mandibular region.
- Avoidance of lingual releasing incisions.

79. MANAGEMENT OF NERVE INJURIES:
• If there is a concern that nerve damage has occurred
during implant placement,the situation should be
assessed soon after the injury.
• First, a CT scan should be obtained to determine if the
altered sensation is due to impingement by the implant
or is the sequela of soft tissue manipulation and edema.
• If the implant itself appears to be the cause of altered
sensation,it should be removed.
• If,however the problem is pressure on the nerve because
of bony compression by the implant,it may be relieved by
withdrawing the implant by 1-2mm.

80. • Because altered sensation can be caused by an inflammatory
reaction,a 3-week course of a steroidal or nonsteroidal anti-
inflammatory drug such as 800mg ibuprofen may be merited.
• If improvement is noted,the clinician can prescribe an additional 3
weeks of anti-inflammatory treatment.
• Medicolegally,it is important to document the patient’s level of
dysfunction postinjury,preferably the day after surgery when the
effects of the anesthetic have worn off.
• The area of decreased or altered sensation should be outlined and
described in detail,including its type and duration and suspected
factors (eg. Anesthesia,flap reflection,compression from implant
placement).
• If a lingual nerve injury is suspected,taste sensation can be tested
with salt and sugar.

81. • In suspected IAN and mental nerve injuries,sensitivity of
the lip and gingiva can be tested with a cotton
swab,thermal sensitivity with ice and a warmed mirror
handle,and the ability to distinguish direction of
movement with a soft brush on the lip and chin with eyes
closed.
• The examination should be repeated after 1 month.
• At this time,complete loss of sensation,diminishing
sensation,or spontaneous pain are signs that normal
sensation is unlikely to return spontaneously.

82. • Prompt referral to a microneurosurgeon is indicated.
• The early referral is to allow the patient to undergo nerve
repair within 4 months of the injury,thereby minimizing
distal degeneration of the nerve.

83. CONCLUSION
Successful treatment is dependent to a large extent on proper anaesthesia of the operative area
and also,careful treatment planning using CT scan images and other diagnostic aids can minimize
the nerve injury.Hence a detailed knowledge of the anatomy of mandibular nerve,its area of
supply,course and distribution will help prevent unnecessary complications.

84. REFERENCES:
• Handbook of Local Anesthesia,Stanley F. Malamed,4th
edition
• B.D.Chaurasia Human Anatomy for Dental Students,5th
edition
• Textbook of Oral and Maxillofacial surgery,S.M.Balaji,1st
edition
• Langlais RP et al,Bifid mandibular canals in panoramic
radiographs,J Am Dent Assoc 110:923-926
• Surgical complications in oral implantology,Louie Al-
Faraje
• Complications in Oral and maxillofacial
surgery,Kaban.Pogrel.Perrott

85. THANK YOU