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Spatial relationships between lingual nerve and mandibular ramus: original study method, clinical and educational

Olivier Trost¹, Apolline Kazemi, Nicolas Cheynel

¹Laboratory of Anatomy, School of Medicine of Dijon, 7 Boulevard Jeanne d'Arc, 21000 Dijon, France. otrost@caramail.com

Surgical and Radiologic Anatomy : SRA

|February 5, 2009

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Lingual nerve damage can be diagnosed via electrographic exploration. This study maps the lingual nerve

Area of Science:

Anatomy
Surgical Navigation
Medical Imaging

Background:

Lingual nerve damage is a complication of oral surgery, necessitating electrographic exploration.
Current methods for direct lingual nerve conduction recording, such as puncture at the foramen ovale, pose significant risks for routine diagnostic use.
Accurate anatomical understanding of the lingual nerve's spatial relationship with the mandibular ramus in the infratemporal fossa is crucial for safer surgical approaches.

Purpose of the Study:

To assess the spatial relationships between the lingual nerve and the mandibular ramus within the infratemporal fossa.
To develop an original technique for improved anatomical visualization and potential diagnostic access to the lingual nerve.
To propose a modified, safer, and reproducible protocol for electrographic exploration of the lingual nerve.

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Main Methods:

Dissection of ten lingual nerves from five fresh cadavers.
Catheterization of dissected nerves with a 3/0 wire.
CT-scan examinations with planar acquisitions and 3D reconstructions after nerve and muscle repositioning.
Assessment of lingual nerve localization at the sigmoid notch, lingula, and third molar levels.

Main Results:

The lingual nerve was found to be distant from the maxillary vessels at the lingula level.
The mean distance between the lingual nerve and the anterior border of the mandibular ramus was 19.6 mm at the lingula.
The angle between the medial side of the ramus and the line joining the lingual nerve and the anterior ramus border measured 17 degrees.

Conclusions:

The anatomical findings suggest the lingual nerve can be accessed via intra-oral puncture at the intermaxillary commissure.
A modified inferior alveolar nerve block technique is proposed as a safe and reproducible protocol for routine electrographic exploration.
The study protocol generated valuable educational materials and supports the development of realistic 3D virtual anatomy supports.