Mandibular Local Anesthesia & Complications

Bismillah..

Mand branch

> branch yg paling besar

composed of sensory and motor roots (mixed)

sensory root
* originates at anterioborder of trigeminal ganglion

motor root
* arises in motor cells located in the pons and medulla lies medial to sensory.

The sensory and motor of the mandibular branch merge from foramen ovale of greater wing of sphenoid.

initially merge outside of the skull and divide about 2-3 mm inferiorly.

branches:
undivided nerve (main trunk)
*nerve spinosus (meningeal branch)
* medial pterygoid motor

anterior division (trunk)
*buccal nerve (long buccal ) sensory
*deep temporal nerve
*masseteric nerve

posterior division (trunk)
* auriculotemporal sensory
*lingual snsory
*inferior alveolar mixed
*mylohyoid nerve (motor)

Main trunk..
1) Branch go up > Nerve spinosus: innervates mastoids and dura
2)Branch go down > media pterygoid: innervates medial pterygoid msucle

ada jugak branches to tensor veli palatini and tensor tympani.

Rule:
1) Anterior trunk ada 3 motor nerves and 1 sensory nerve
( innervates muslce of mastication)

muscle of mastication(mylohyoid) yg innervated by post trunk  called : nerve to mylohyoid

a) Buccal nerve (long buccal): sensory
-kalau nak anesthesize inject 2mm distobuccal to the tooth that you want to extract.

Travels anteriorly and lateral to the lateral pterygoid muslce

kat mand 3rd molar: exit through buccinator and provide innervation to skin of cheek.

branches also stay within the retromandibular triangle providing sensory innervation to the buccal gingiva of mand molars and buccal vestibule.


b) Muscles of mastication

V3: gives branches to deep temporal muslce (temporalis muscle), masseter and lateral pterygoid muscle (motor branches of ant division of V3

Post trunk: 3 sensory 1 motor nerve

So kat ant of V3 sensory: buccal nerve...yg lain tu motor (nerves to mastication muscle)

travels inferior and mesial to lateral pterygoid

1) lingual nerve

lies between ramus and medial pterygoid within pterygomandibular raphe.

provide sensation to ant 2/3 rds of tongue, lingual gingiva, floor of mouth mucosa and gustation (chorda tympani)

carries nerve yg bukan part of trigeminal nerve including chorda tmypani nerve of the facial nerve, which provides special sensation (taste) to anterior 2/3 part of tongue)

sgt ada kaitan dgn mandible, esp in the mandibular posterior wisdom area.

lies inferior and mesial to mand 3rd molar
descend from post trunk of V3> go down to lingual plate "lingual cortex"

sgt berisiko utk terkena nerve ni bila cabut 3rd molar(gigi bongsu).

kalau nerve ni rosak ggu sensation

auriculotemporal nerve (sensory)
-depan telinga
- transverses the upper part of parotid gland and post portion of zygomatic arch.

Branches: supply

Anterior auricular: skin over helix and tragus

External auditory meatus: skin over meatus and tympanic

communicates with facial nerve to provide sensory innervation to the skin over areas of zygomatic, buccal and mandibular.

communicates with otic ganglion for sensory, secretory and vasomotor fibers to the parotid gland a

articular-posterior TMJ sensation to the capsule of TMJ.

superficial temporal - skin over temporal region.

TO BE CONTINUE....