Spatial relationships between lingual nerve and mandibular ramus: original study method, clinical and educational applications.
Lingual nerve damage complicating oral surgery would sometimes require electrographic exploration. Nevertheless, direct recording of conduction in lingual nerve requires its puncture at the foramen ovale. This method is too dangerous to be practiced routinely in these diagnostic indications. The aim of our study was to assess spatial relationships between lingual nerve and mandibular ramus in the infratemporal fossa using an original technique. Therefore, ten lingual nerves were dissected on five fresh cadavers. All the nerves were catheterized with a 3/0 wire. After meticulous repositioning of the nerve and medial pterygoid muscle reinsertion, CT-scan examinations were performed with planar acquisitions and three-dimensional reconstructions. Localization of lingual nerve in the infratemporal fossa was assessed successively at the level of the sigmoid notch of the mandible, lingula and third molar. At the level of the lingula, lingual nerve was far from the maxillary vessels; mean distance between the nerve and the anterior border of the ramus was 19.6 mm. The posteriorly opened angle between the medial side of the ramus and the line joining the lingual nerve and the anterior border of the ramus measured 17 degrees . According to these findings, we suggest that the lingual nerve might be reached through the intra-oral puncture at the intermaxillary commissure; therefore, we modify the inferior alveolar nerve block technique to propose a safe and reproducible protocol likely to be performed routinely as electrographic exploration of the lingual nerve. What is more, this original study protocol provided interesting educational materials and could be developed for the conception of realistic 3D virtual anatomy supports.
Trost
Olivier
O
Laboratory of Anatomy, School of Medicine of Dijon, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France. otrost@caramail.com
Kazemi
Apolline
A
Cheynel
Nicolas
N
Benkhadra
Mehdi
M
Soichot
Pierre
P
Malka
Gabriel
G
Trouilloud
Pierre
P
D002404:Catheterization; D005260:Female; D006801:Humans; D008036:Lingual Nerve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008297:Male; D008334:Mandible / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008340:Mandibular Nerve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D008875:Middle Aged; D011859:Radiography