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Tsakiris E, Kitagawa N, Fukino K, Shekhawat D, Iwanaga J, Tubbs RS. A rare case of the auriculotemporal and inferior alveolar nerves communication. Surg Radiol Anat 2024; 46:191-194. [PMID: 38151551 DOI: 10.1007/s00276-023-03283-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023]
Abstract
This case study describes anatomical variations in the branching pattern of the posterior division of the trigeminal nerve and its clinical implications for dental and craniofacial surgery. The study presents two uncommon variations observed in an elderly male cadaver. A communicating branch connecting one of three roots of the auriculotemporal nerve and inferior alveolar nerve just before entering the mandibular foramen on the right side, and three communicating branches between the IAN and lingual nerve on the left side. The presence of such variations may complicate anesthesia associated with oral surgery procedures.
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Affiliation(s)
- Eli Tsakiris
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Norio Kitagawa
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Fukino
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Devendra Shekhawat
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA
| | - Joe Iwanaga
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA.
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA.
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA.
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA, 70112, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- University of Queensland, Brisbane, Australia
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Tritsch T, Shoja MM, Tubbs RS. Antegrade Auriculotemporal-Inferior Alveolar Nerve Communication in the Infratemporal Fossa. Cureus 2023; 15:e50526. [PMID: 38226093 PMCID: PMC10788315 DOI: 10.7759/cureus.50526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024] Open
Abstract
Communications between cranial nerves or their branches have been described previously. The exact functional significance of some of these neural communications remains to be fully understood. This paper reports a unique communication between the auriculotemporal and inferior alveolar nerves within the infratemporal fossa. The histological examination indicates an antegrade connection from the inferior alveolar nerve to the auriculotemporal nerve, which could potentially be implicated in referred pain from the anatomical territory of one nerve to the other.
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Affiliation(s)
- Tara Tritsch
- Medical Education, Nova Southeastern University, Fort Lauderdale, USA
| | | | - R Shane Tubbs
- Anatomical Sciences, St. George's University, St. George's, GRD
- Neurosurgery and Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, USA
- Neurosurgery and Ochsner Neuroscience, Ochsner Health System, New Orleans, USA
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Tereshko Y, Belgrado E, Lettieri C, Gigli GL, Valente M. Botulinum Toxin Type A for the Treatment of Auriculotemporal Neuralgia-A Case Series. Toxins (Basel) 2023; 15:toxins15040274. [PMID: 37104212 PMCID: PMC10141838 DOI: 10.3390/toxins15040274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/28/2023] Open
Abstract
Auriculotemporal neuralgia is a rare pain disorder in which anesthetic nerve blockade is usually effective but not always resolutive. Botulinum toxin type A has proven to be effective in treating neuropathic pain, and patients with auriculotemporal neuralgia could also benefit from this treatment. We described nine patients with auriculotemporal neuralgia treated with botulinum toxin type A in the territory of auriculotemporal nerve innervation. We compared the basal NRS and Penn facial pain scale scores with those obtained 1 month after BoNT/A injections. Both Penn facial pain scale (96.67 ± 24.61 vs. 45.11 ± 36.70, p 0.004; mean reduction 52.57 ± 36.50) and NRS scores (8.11 ± 1.27 vs. 4.22 ± 2.95, p 0.009; mean reduction 3.89 ± 2.52) improved significantly at one month after treatment. The mean duration of the effect of BoNT/A on pain was 95.00 ± 53.03 days and no adverse effects were reported.
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Affiliation(s)
- Yan Tereshko
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Enrico Belgrado
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Christian Lettieri
- Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Gian Luigi Gigli
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Udine University Hospital, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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Simon KS, Rout S, Lionel KR, Joel JJ, Daniel P. Anatomical considerations of cutaneous nerves of scalp for an effective anesthetic blockade for procedures on the scalp. J Neurosci Rural Pract 2023; 14:62-69. [PMID: 36891119 PMCID: PMC9945310 DOI: 10.25259/jnrp-2022-2-4-r2-(2362)] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/12/2022] [Indexed: 01/03/2023] Open
Abstract
Objective The anatomy of the scalp nerves varies widely with age, race, and individuals of the same race and even within the same individual and hence need to be studied extensively to avoid complications and improve effectiveness during various surgical and anesthetic procedures of the scalp. Materials and Methods Gross dissection was carried out on 11 cadavers (22 Hemifaces: 11 right and 11 left) with no obvious scalp deformities or surgeries. The distances of the supraorbital nerve (SON), supratrochlear nerve (STN), and greater occipital nerve (GON) from commonly used bony landmarks were measured. The branching pattern and presence of accessory notches/foramina were noted. Results SON and STN were found almost midway and at the junction between medial and middle one-third of the line joining midline and lateral orbital margin, respectively. The distances of STN and SON from the midline were about ½ and 3/4th of the transverse orbital diameters of the individual. GON was found at the medial 2/5 and lateral 3/5 of the line joining inion to the mastoid. In 40.9% cases, SON gave three branches while STN and GON remained as single trunks in 77.27% and 40.0% cases, respectively. Accessory foramina/notches for SON and STN were found in 36.36% and 4.54% of the specimen, respectively. SON and STN remained lateral in the majority while GON ran medially to corresponding vessels. Conclusion These parameters on the Indian population would give a comprehensive idea of the distribution of these cutaneous scalp nerves and would be beneficial in the targeted and accurate deposition of local anesthetic.
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Affiliation(s)
| | - Sipra Rout
- Department of Anatomy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Karen Ruby Lionel
- Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jerry Joseph Joel
- Department of Anaesthesia and Critical Care, Maidstone and Tunbridge Wells NHS Trust, Royal Tunbridge Wells, United Kingdom
| | - Priyanka Daniel
- Department of Anatomy, St George’s University of London, United Kingdom
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Effectiveness and Distribution of Anesthesia for a Modified Extra Oral Maxillo-Mandibular Nerve Block for Dento-Alveolar Procedures: A Prospective Cohort Study. J Maxillofac Oral Surg 2022. [DOI: 10.1007/s12663-022-01755-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gebara MA, Iwanaga J, Dumont AS, Tubbs RS. Nervous Interconnection Between the Lesser Occipital and Auriculotemporal Nerves. Cureus 2022; 14:e25643. [PMID: 35795503 PMCID: PMC9251152 DOI: 10.7759/cureus.25643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/17/2022] Open
Abstract
The auriculotemporal nerve is one branch of the mandibular portion of the trigeminal nerve, which itself divides into several branches in the temporal and retromandibular regions. The lesser occipital nerve is a cutaneous branch of the cervical plexus and is sometimes implicated in cases of cervicogenic headaches, occipitoparietal headaches, and occipital neuralgia, in general. Here, we present a case of unilateral neural interconnection between the auriculotemporal and lesser occipital nerves thus illustrating the joining of the cervical plexus and trigeminal nerve. A better understanding of the aforementioned nervous anatomy may be valuable for facial reconstructive and nerve transfer procedures, as well as for a variety of other head and neck disorders, e.g., occipital neuralgia.
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Irimia A, Van Horn JD. Mapping the rest of the human connectome: Atlasing the spinal cord and peripheral nervous system. Neuroimage 2021; 225:117478. [PMID: 33160086 PMCID: PMC8485987 DOI: 10.1016/j.neuroimage.2020.117478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
The emergence of diffusion, structural, and functional neuroimaging methods has enabled major multi-site efforts to map the human connectome, which has heretofore been defined as containing all neural connections in the central nervous system (CNS). However, these efforts are not structured to examine the richness and complexity of the peripheral nervous system (PNS), which arguably forms the (neglected) rest of the connectome. Despite increasing interest in an atlas of the spinal cord (SC) and PNS which is simultaneously stereotactic, interactive, electronically dissectible, scalable, population-based and deformable, little attention has thus far been devoted to this task of critical importance. Nevertheless, the atlasing of these complete neural structures is essential for neurosurgical planning, neurological localization, and for mapping those components of the human connectome located outside of the CNS. Here we recommend a modification to the definition of the human connectome to include the SC and PNS, and argue for the creation of an inclusive atlas to complement current efforts to map the brain's human connectome, to enhance clinical education, and to assist progress in neuroscience research. In addition to providing a critical overview of existing neuroimaging techniques, image processing methodologies and algorithmic advances which can be combined for the creation of a full connectome atlas, we outline a blueprint for ultimately mapping the entire human nervous system and, thereby, for filling a critical gap in our scientific knowledge of neural connectivity.
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Affiliation(s)
- Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles CA 90089, United States; Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, United States.
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, 485 McCormick Road, Gilmer Hall, Room 102, Charlottesville, Virginia 22903, United States; School of Data Science, University of Virginia, Dell 1, Charlottesville, Virginia 22903, United States.
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Zetlaoui PJ, Gauthier E, Benhamou D. Ultrasound-guided scalp nerve blocks for neurosurgery: A narrative review. Anaesth Crit Care Pain Med 2020; 39:876-882. [DOI: 10.1016/j.accpm.2020.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
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Vadhanan P. Successful use of Gasserian ganglion block for maxillo-mandibular fixation in a patient with severe pulmonary dysfunction: a case report. J Dent Anesth Pain Med 2020; 20:331-335. [PMID: 33195811 PMCID: PMC7644356 DOI: 10.17245/jdapm.2020.20.5.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022] Open
Abstract
Various anesthetic techniques have been utilized for maxillo-mandibular fixation. We report the case of a patient with bilateral condylar and zygomatic arch fractures who had severe pulmonary dysfunction. The patient was administered bilateral image-guided Gasserian ganglion block through the foramen ovale to achieve surgical anesthesia. The technical details, advantages, and disadvantages of this rather unusual technique are discussed. The procedure could be a feasible technique when performed meticulously in cases where other approaches are deemed difficult.
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Affiliation(s)
- Prasanna Vadhanan
- Department of Anaesthesiology, Vinayaka Missions Medical College, Vinayaka Missions Research foundation, Karaikal, Puducherry, India.,Vairam Multispeciality Hospitals, Mayiladuthurai, India
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Nayak U, Vadgaonkar R, Pai MM, Murlimanju BV. A case of inferior alveolar nerve encircling the arteria maxillaris. Anat Cell Biol 2020; 53:240-243. [PMID: 32647091 PMCID: PMC7343564 DOI: 10.5115/acb.19.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/04/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022] Open
Abstract
Here we report a case of inferior alveolar nerve (IAN), which had variability in its formation. IAN was formed by dual roots, which were branching out from the posterior division of mandibular nerve. The observed roots were forming a loop around the pterygoid part of arteria maxillaris (MA). One of the roots was superficial to the MA and the other was deep to it. It is believed that this type of morphological variation in the formation of IAN can have clinial implications, which include compression by adjacent structures and nerve entrapment. The knowledge of this variation is important to anaesthesiologists and dentists, while administering local anaesthesia. This is also enlightening to the maxillofacial surgeons, neurologists and radiologists.
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Affiliation(s)
- Unnathi Nayak
- Third Semester MBBS Student, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajanigandha Vadgaonkar
- Department of Anatomy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mangala M Pai
- Department of Anatomy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B V Murlimanju
- Department of Anatomy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Barkhordarian A, Demerjian G, Chiappelli F. Translational research of temporomandibular joint pathology: a preliminary biomarker and fMRI study. J Transl Med 2020; 18:22. [PMID: 31931814 PMCID: PMC6956559 DOI: 10.1186/s12967-019-02202-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/30/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The temporomandibular joint (TMJ) is well innervated by braches of the trigeminal nerve. The temporomandibular joint disorders (TMD) can cause neural-inflammation in the peripheral nervous system (PNS) at the site of injury, or compression, and may have systemic effects on the central nervous system (CNS). Neural-inflammation causes elevations in cytokine expression and microglia activation. When the site of injury, or compression is treated, or relieved, neural inflammation is reduced. These changes can be seen and measured with fMRI brain activities. METHODS For this study, patients with comorbid TMD and systemic/neurologic conditions were compared using clinical diagnostic markers, inflammatory, pain, tissue destruction enzymatic biomarkers, and functional magnetic resonance imaging (fMRI) activity of the brain, with and without a custom-made dental orthotic. RESULTS Our results showed a correlation between the clinical diagnosis of the pathological TMJ, biomarkers and the fMRI study. There was a marked elevation of biomarkers in samples taken from TMJ of patients who were clinically diagnosed with TMD. The fMRI study of TMD patients showed an abnormal hyper-connected salience network and a diminished blood flow to the anterior frontal lobes when they did not wear their customized dental orthotics. CONCLUSIONS Our findings highlight the importance of TMJ-CNS connections and use of fMRI as an investigative tool for understanding TMD and its related neurological pathologies.
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Affiliation(s)
- Andre Barkhordarian
- University of California Los Angeles, School of Dentistry, Division of Oral Biology and Medicine, Los Angeles, USA.
| | - Gary Demerjian
- University of California Los Angeles, School of Dentistry, Division of Oral Biology and Medicine, Los Angeles, USA
| | - Francesco Chiappelli
- University of California Los Angeles, School of Dentistry, Division of Oral Biology and Medicine, Los Angeles, USA
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Surgical Therapy of Temporal Triggered Migraine Headache. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1980. [PMID: 30656098 PMCID: PMC6326627 DOI: 10.1097/gox.0000000000001980] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022]
Abstract
Background The auriculotemporal and zygomaticotemporal nerves are the 2 primary trigger points in the temporal area of migraine headache. Different surgical approaches are described in literature, either open or endoscopic ones. Methods We described and delineated the currently adopted strategies to treat temporal trigger points in migraine headache. Furthermore, we reported our personal experience in the field. Results Regardless of the type of approach, outcomes observed were similar and ranged from 89% to 67% elimination / >50% reduction rates. All procedures are minimally invasive and only minor complications are reported, with an incidence ranging from 1% to 5%. Conclusions Just like upper limb compressive neuropathies, migraine headache is believed to be caused by chronic compression of peripheral nerves (ie, the terminal branches of trigeminal nerve) caused by surrounding structures (eg, muscles, vessels, and fascial bands) the removal of which eventually results in improvement or elimination of migraine attacks. Particular attention should be paid to the close nerve/artery relationship often described in anatomical studies and clinical reports.
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Parotid Branches of the Auriculotemporal Nerve: An Anatomical Study With Implications for Frey Syndrome. J Craniofac Surg 2016; 28:262-264. [PMID: 27930465 DOI: 10.1097/scs.0000000000003260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The auriculotemporal nerve is one of the many branches of the mandibular division of the trigeminal nerve. Of these, its superficial temporal branch has been most described. Although the parotid branches, secretomotor fibers to the parotid gland, are well known as the cause of Frey syndrome, there have been almost no descriptions of their anatomy. In this study, the authors dissected the parotid branches of the auriculotemporal nerve to elucidate their anatomy. A total of 10 sides from 7 adult and embalmed cadaver heads were used in this study. The specimens were derived from 3 males and 4 females, the age of cadavers at death ranged from 65 to 92 years old. Measurements included their diameter and the distance of their branching point from the main trunk of the auriculotemporal nerve from the middle of the tragus. Three of 10 sides had 2 parotid branches and 7 sides were found to have 1 parotid branch. The vertical distance between middle of the tragus to branching point of the parotid branch ranged from 1.79 to 16.17 mm. The horizontal distance between middle of the tragus to branching point of the parotid branch ranged from 3.03 to 12.62 mm. The diameter of the parotid branch ranged from 0.31 to 0.49 mm. An improved knowledge of the parotid branch of the auriculotemporal nerve might decrease injury to these structures with the potential for postoperative.
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Wolf KT, Brokaw EJ, Bell A, Joy A. Variant Inferior Alveolar Nerves and Implications for Local Anesthesia. Anesth Prog 2016; 63:84-90. [PMID: 27269666 DOI: 10.2344/0003-3006-63.2.84] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A sound knowledge of anatomical variations that could be encountered during surgical procedures is helpful in avoiding surgical complications. The current article details anomalous morphology of inferior alveolar nerves encountered during routine dissection of the craniofacial region in the Gross Anatomy laboratory. We also report variations of the lingual nerves, associated with the inferior alveolar nerves. The variations were documented and a thorough review of literature was carried out. We focus on the variations themselves, and the clinical implications that these variations present. Thorough understanding of variant anatomy of the lingual and inferior alveolar nerves may determine the success of procedural anesthesia, the etiology of pathologic processes, and the avoidance of surgical misadventure.
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Affiliation(s)
- Kevin T Wolf
- Research Assistant, Section of Anatomy, Department of Growth, Development and Structure, Southern Illinois University School of Dental Medicine, Edwardsville, Illinois
| | - Everett J Brokaw
- Research Assistant, Section of Anatomy, Department of Growth, Development and Structure, Southern Illinois University School of Dental Medicine, Edwardsville, Illinois
| | - Andrea Bell
- Assistant Professor, Section of Pediatric Dentistry, Department of Growth, Development and Structure, Southern Illinois University School of Dental Medicine, Edwardsville, Illinois, and
| | - Anita Joy
- Associate Professor and Section Head of Anatomy, Department of Growth, Development and Structure, Southern Illinois University School of Dental Medicine, Edwardsville, Illinois
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Intraparotid Location of the Great Auricular Nerve: A New Anatomical Basis for Gustatory Sweating Syndrome. Plast Reconstr Surg 2016; 136:1069-1081. [PMID: 26505708 DOI: 10.1097/prs.0000000000001726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gustatory sweating syndrome (also known as Frey syndrome or auriculotemporal nerve syndrome) is thought to result from a lesion of the auriculotemporal nerve. A lesion of this nerve can lead to aberrant regeneration of nerve fibers to the sweat glands and blood vessels. The occurrence of signs outside the region of the auriculotemporal nerve prompted the author to search for another anatomical basis for this syndrome. METHODS The author dissected 46 great auricular nerves from their origin to the parotid gland and in the infratemporal fossa. The author investigated the different connections of the great auricular nerve with the facial nerve and the auriculotemporal nerve. RESULTS The great auricular nerve was found to essentially be a parotid nerve. There was a set of intraparotid nerve connections on 14 of the 46 half-heads that were dissected. The author was able to discern three types of parotid great auricular nerve connections, which he designates as either type 1, connection with the trunk of the facial nerve and its branches; type 2, connection with the auriculotemporal nerve; or type 3, connection with the auriculotemporal nerve and the facial nerve with the formation of an intraparotid nerve circle. CONCLUSIONS Having clearly established the nerve connections of the great auricular nerve, the author believes that it is primarily this nerve that is responsible for gustatory sweating syndrome. This allows for a better understanding of the sympathetic nervous system features and the manifestation of the syndrome outside the region of the auriculotemporal nerve.
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Tansatit T, Apinuntrum P, Phetudom T. Evidence Suggesting that the Buccal and Zygomatic Branches of the Facial Nerve May Contain Parasympathetic Secretomotor Fibers to the Parotid Gland by Means of Communications from the Auriculotemporal Nerve. Aesthetic Plast Surg 2015; 39:1010-7. [PMID: 26498314 DOI: 10.1007/s00266-015-0573-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The auriculotemporal nerve is one of the peripheral nerves that communicates with the facial nerve. However, the function of these communications is poorly understood. Details of how these communications form and connect with each other are still unclear. In addition, a reliable anatomical landmark for locating these communications during surgery has not been sufficiently described. METHODS Microdissection was performed on 20 lateral hemifaces of 10 soft-embalmed cadavers to investigate facial-auriculotemporal nerve communications with emphasis on determining their function. The auriculotemporal nerve was identified in the retromandibular space and traced towards its terminations. The communicating branches were followed and the anatomical relationships to surrounding structures observed. RESULTS The auriculotemporal nerve is suspended above the maxillary artery in the dense retromandibular fascia behind the mandibular ramus. It forms a knot and fans out, providing multiple branches in all directions in the sagittal plane. Inferiorly, it connects the maxillary periarterial plexus, while minute branches supply the temporomandibular joint anteriorly. The larger branches mainly communicate with the branches of the temporofacial division of the facial nerve, and the auricular branches enter the fascia of the auricular cartilage posteriorly. The temporal branches and occasionally the zygomatic branches arise superiorly to distribute within the temporoparietal fascia. The auriculotemporal nerve forms the parotid retromandibular plexus through two types of communication. It sends one to three branches to join the zygomatic and buccal branches of the facial nerve at the branching area of the temporofacial division. It also communicates with the periarterial plexus of the superficial temporal and maxillary arteries. This plexus continues anteriorly along the branches of the facial nerve and the periarterial plexus of the transverse facial artery as the parotid periductal autonomic plexus, supplying the branches of the parotid duct within the loop of the two main divisions of the parotid gland. CONCLUSION A single cutaneous zygomatic branch arising from the auriculotemporal nerve in some specimens, the intraparotid communications with the zygomatic and the buccal trunks of the facial nerve, the retromandibular communications with the superficial temporal-maxillary periarterial plexuses, and the periductal autonomic plexus between the loop of the two main facial divisions lead to the suggestion that these communications of the auriculotemporal nerve convey the secretomotor to the zygomatic and buccal branches of the facial nerve. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Tanvaa Tansatit
- The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Prawit Apinuntrum
- The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
| | - Thavorn Phetudom
- The Chula Soft Cadaver Surgical Training Center and Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok, 10330, Thailand
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Komarnitki I, Tomczyk J, Ciszek B, Zalewska M. Proposed classification of auriculotemporal nerve, based on the root system. PLoS One 2015; 10:e0123120. [PMID: 25856464 PMCID: PMC4391942 DOI: 10.1371/journal.pone.0123120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 02/21/2015] [Indexed: 01/14/2023] Open
Abstract
The topography of the auriculotemporal nerve (ATN) root system is the main criterion of this nerve classification. Previous publications indicate that ATN may have between one and five roots. Most common is a one- or two-root variant of the nerve structure. The problem of many publications is the inconsistency of nomenclature which concerns the terms “roots”, “connecting branches”, or “branches” that are used to identify the same structures. This study was performed on 80 specimens (40 adults and 40 fetuses) to propose a classification based on: (i) the number of roots, (ii) way of root division, and (iii) configuration of interradicular fibers that form the ATN trunk. This new classification is a remedy for inconsistency of nomenclature of ATN in the infratemporal fossa. This classification system has proven beneficial when organizing all ATN variants described in previous studies and could become a helpful tool for surgeons and dentists. Examination of ATN from the infratemporal fossa of fetuses (the youngest was at 18 weeks gestational age) showed that, at that stage, the nerve is fully developed.
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Affiliation(s)
- Iulian Komarnitki
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
- * E-mail:
| | - Jacek Tomczyk
- Department of Biological Anthropology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Bogdan Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - Marta Zalewska
- Department of Environmental Hazard Prevention and Allergology, Medical University of Warsaw, Warsaw, Poland
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18
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The origin of the auriculotemporal nerve and its relationship to the middle meningeal artery. Anat Sci Int 2014; 90:216-21. [PMID: 24973088 DOI: 10.1007/s12565-014-0247-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/14/2014] [Indexed: 10/25/2022]
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19
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Geerse WK, von Piekartz HJM. Ear pain following temporomandibular surgery originating from the temporomandibular joint or the cranial nervous tissue? A case report. ACTA ACUST UNITED AC 2014; 20:212-5. [PMID: 24948551 DOI: 10.1016/j.math.2014.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 05/08/2014] [Accepted: 05/13/2014] [Indexed: 11/18/2022]
Abstract
A patient presenting with local pain and limitation of movement in the temporomandibular region following surgery of the left temporomandibular joint (TMJ) is described. Manual techniques like distraction of the TMJ combined with motor control exercises to restore TMJ function were not sufficient to relieve the patient's symptoms and her orofacial functions. However, during manual assessment and treatment of cranial nervous tissue, in this case the auriculotemporal nerve and its interface, pain was relieved and orofacial functions improved.
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20
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Orita Y, Ogawara T, Endo R, Fuji S, Miki K, Hirai M, Noda Y, Marunaka H, Tachibana T, Sato Y, Nishizaki K. Leriche operation for parotid gland pathology. Acta Otolaryngol 2014; 134:413-5. [PMID: 24444373 DOI: 10.3109/00016489.2013.871749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yorihisa Orita
- Departments of Otolaryngology, Head and Neck Surgery, Okayama
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21
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Joo W, Yoshioka F, Funaki T, Mizokami K, Rhoton AL. Microsurgical anatomy of the trigeminal nerve. Clin Anat 2013; 27:61-88. [PMID: 24323792 DOI: 10.1002/ca.22330] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/05/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Wonil Joo
- Department of Neurosurgery; Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine; Seoul South Korea
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Fumitaka Yoshioka
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Takeshi Funaki
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Koji Mizokami
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Albert L. Rhoton
- Department of Neurosurgery; University of Florida; Gainesville Florida
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22
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Shoja MM, Oyesiku NM, Griessenauer CJ, Radcliff V, Loukas M, Chern JJ, Benninger B, Rozzelle CJ, Shokouhi G, Tubbs RS. Anastomoses between lower cranial and upper cervical nerves: a comprehensive review with potential significance during skull base and neck operations, part I: trigeminal, facial, and vestibulocochlear nerves. Clin Anat 2013; 27:118-30. [PMID: 24272859 DOI: 10.1002/ca.22340] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/05/2013] [Indexed: 11/07/2022]
Abstract
Descriptions of the anatomy of the neural communications among the cranial nerves and their branches is lacking in the literature. Knowledge of the possible neural interconnections found among these nerves may prove useful to surgeons who operate in these regions to avoid inadvertent traction or transection. We review the literature regarding the anatomy, function, and clinical implications of the complex neural networks formed by interconnections among the lower cranial and upper cervical nerves. A review of germane anatomic and clinical literature was performed. The review is organized in two parts. Part I concerns the anastomoses between the trigeminal, facial, and vestibulocochlear nerves or their branches with any other nerve trunk or branch in the vicinity. Part II concerns the anastomoses among the glossopharyngeal, vagus, accessory and hypoglossal nerves and their branches or among these nerves and the first four cervical spinal nerves; the contribution of the autonomic nervous system to these neural plexuses is also briefly reviewed. Part I is presented in this article. An extensive anastomotic network exists among the lower cranial nerves. Knowledge of such neural intercommunications is important in diagnosing and treating patients with pathology of the skull base.
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Affiliation(s)
- Mohammadali M Shoja
- Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama; Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama; Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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23
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Thotakura B, Rajendran SS, Gnanasundaram V, Subramaniam A. Variations in the posterior division branches of the mandibular nerve in human cadavers. Singapore Med J 2013; 54:149-51. [PMID: 23546028 DOI: 10.11622/smedj.2013051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The lingual, inferior alveolar and auriculotemporal nerves, being branches of the posterior division of the mandibular nerve, mainly innervate the mandibular teeth and all the major salivary glands. Anomalous communications among these branches are widely reported due to their significance to various treatment procedures undertaken in the region. This study was performed as detailed exploration of the functional perspectives of such communicating branches would further enhance the scope of these procedures. METHODS A total of 36 specimens were dissected to examine the infratemporal region. The branches from the posterior division of the mandibular nerve--namely the lingual, inferior alveolar and auriculotemporal nerves--were carefully dissected, and their branches were studied and analysed for abnormal course. RESULTS Communication between branches of the posterior division of the mandibular nerve was observed in four specimens. In two of the four specimens, communication between the mylohyoid and lingual nerves was observed. A rare and seldom reported type of communication between the auriculotemporal and inferior alveolar nerves is described in this study. This communicating nerve split into two to form a buttonhole for the passage of the mylohyoid nerve. CONCLUSION Such communicating branches between nerves found in this study are developmental in origin and thought to maintain functional integrity through an alternative route.
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Affiliation(s)
- Balaji Thotakura
- Department of Anatomy, Chettinad Hospital and Research Institute, Kanchipuram, India.
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Nowinski WL, Johnson A, Chua BC, Nowinska NG. Three-dimensional interactive and stereotactic atlas of the cranial nerves and their nuclei correlated with surface neuroanatomy, vasculature and magnetic resonance imaging. J Neurosci Methods 2012; 206:205-16. [DOI: 10.1016/j.jneumeth.2012.02.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/29/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
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Buch HA, Agnihotri RG. A recurrent variant branch of the inferior alveolar nerve: is it unique? Clin Anat 2012; 25:437-43. [PMID: 22302685 DOI: 10.1002/ca.22040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 12/20/2011] [Accepted: 01/10/2012] [Indexed: 11/06/2022]
Abstract
The only named branch of the inferior alveolar nerve (IAN) before it enters the mandibular foramen is the mylohyoid nerve. However, several variations have been reported in the literature. In this study, a recurrent variant branch of the IAN arising just below the origin of the mylohyoid nerve was investigated in adult Indian cadavers allotted for dissection to the first year dental students of Government Dental College, Ahmedabad (India). The dissection was performed by the lateral approach to the infratemporal fossa. The nerve was found in 12 of 35 sides (34.3%) and 8 of 18 cadavers (44.4%). Thus, in our study it was not a rare variation of the IAN, where in most cases it innervated the lateral pterygoid muscle. In some cases, it terminated in the lateral pterygoid muscle. In others, it penetrated the muscle to join the anterior or posterior division of the mandibular nerve or its branches; thus, the variant nerve in such cases might be regarded as an additional root of the IAN. Because the concerned primordia of the nerves and muscles migrate extensively during development and growth, alternative routes of migration may bring about variants like the one under study. The variant appeared to be unique in some of its features. It may be a source of neuropathic and referred pain. Failure of the conventional inferior alveolar nerve block anesthesia and the peripheral neurectomy used for the treatment of trigeminal neuralgia may be partly due to the presence of this variation.
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Affiliation(s)
- Hasmukh A Buch
- Department of Human Anatomy, Faculty of Dental Science, Dharmsinh Desai University, Nadiad-Gujarat, India.
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Rodella LF, Buffoli B, Labanca M, Rezzani R. A review of the mandibular and maxillary nerve supplies and their clinical relevance. Arch Oral Biol 2011; 57:323-34. [PMID: 21996489 DOI: 10.1016/j.archoralbio.2011.09.007] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 09/15/2011] [Accepted: 09/20/2011] [Indexed: 11/26/2022]
Abstract
Mandibular and maxillary nerve supplies are described in most anatomy textbooks. Nevertheless, several anatomical variations can be found and some of them are clinically relevant. Several studies have described the anatomical variations of the branching pattern of the trigeminal nerve in great detail. The aim of this review is to collect data from the literature and gives a detailed description of the innervation of the mandible and maxilla. We carried out a search of studies published in PubMed up to 2011, including clinical, anatomical and radiological studies. This paper gives an overview of the main anatomical variations of the maxillary and mandibular nerve supplies, describing the anatomical variations that should be considered by the clinicians to understand pathological situations better and to avoid complications associated with anaesthesia and surgical procedures.
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Affiliation(s)
- L F Rodella
- Division of Human Anatomy, Department of Biomedical Sciences and Biotechnologies, University of Brescia, Viale Europa 11, Brescia, Italy
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Anatomy of the Auriculotemporal Nerve: Variations in Its Relationship to the Superficial Temporal Artery and Implications for the Treatment of Migraine Headaches. Plast Reconstr Surg 2010; 125:1422-1428. [DOI: 10.1097/prs.0b013e3181d4fb05] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Jeong SM, Park KJ, Kang SH, Shin HW, Kim H, Lee HK, Chung YG. Anatomical consideration of the anterior and lateral cutaneous nerves in the scalp. J Korean Med Sci 2010; 25:517-22. [PMID: 20357990 PMCID: PMC2844612 DOI: 10.3346/jkms.2010.25.4.517] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 07/28/2009] [Indexed: 11/20/2022] Open
Abstract
To better understand the anatomic location of scalp nerves involved in various neurosurgical procedures, including awake surgery and neuropathic pain control, a total of 30 anterolateral scalp cutaneous nerves were examined in Korean adult cadavers. The dissection was performed from the distal to the proximal aspects of the nerve. Considering the external bony landmarks, each reference point was defined for all measurements. The supraorbital nerve arose from the supraorbital notch or supraorbital foramen 29 mm lateral to the midline (range, 25-33 mm) and 5 mm below the supraorbital upper margin (range, 4-6 mm). The supratrochlear nerve exited from the orbital rim 16 mm lateral to the midline (range, 12-21 mm) and 7 mm below the supraorbital upper margin (range, 6-9 mm). The zygomaticotemporal nerve pierced the deep temporalis fascia 10 mm posterior to the frontozygomatic suture (range, 7-13 mm) and 22 mm above the upper margin of the zygomatic arch (range, 15-27 mm). In addition, three types of zygomaticotemporal nerve branches were found. Considering the superficial temporal artery, the auriculotemporal nerve was mostly located superficial or posterior to the artery (80%). There were no significant differences between the right and left sides or based on gender (P>0.05). These data can be applied to many neurosurgical diagnostic or therapeutic procedures related to anterolateral scalp cutaneous nerve.
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Affiliation(s)
- Seong Man Jeong
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Numbness of the ear following inferior alveolar nerve block: the forgotten complication. Br Dent J 2009; 207:19-21. [PMID: 19590550 DOI: 10.1038/sj.bdj.2009.559] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2009] [Indexed: 11/08/2022]
Abstract
This article presents a distant complication in the auricle following the administration of a standard inferior alveolar nerve block. The patient experienced profound numbness of the auricle on the ipsilateral side of the injection that lasted for about an hour following unintended injection to the auriculotemporal nerve.
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30
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Soni S, Rath G, Suri R, Vollala VR. Unusual Organization of Auriculotemporal Nerve and Its Clinical Implications. J Oral Maxillofac Surg 2009; 67:448-50. [DOI: 10.1016/j.joms.2008.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 08/01/2008] [Accepted: 09/05/2008] [Indexed: 11/17/2022]
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31
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Decuadro-Sáenz G, Castro G, Sorrenti N, Doassans I, Deleon S, Salle F, Saibene A, Santamaría A, Soria-Vargas V, Pérez-Brignani A. El nervio auriculotemporal. Bases neuroanatómicas del Síndrome de Frey. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70241-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ayesh EE, Ernberg M, Svensson P. Effects of local anesthetics on somatosensory function in the temporomandibular joint area. Exp Brain Res 2007; 180:715-25. [PMID: 17588187 DOI: 10.1007/s00221-007-0893-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2006] [Accepted: 01/24/2007] [Indexed: 10/23/2022]
Abstract
There is a need for systematic studies regarding the pathophysiology and pain mechanisms of somatosensory function in the temporomandibular joint (TMJ). So far, the effects on somatosensory functions of local anesthetics (LA) applied to the auriculotemporal (AT) nerve or intraarticularly (IA) into the TMJ have not been studied systemically. This study aimed to examine in a double-blinded, placebo-controlled manner the effects of LA on mechanical and thermal sensitivity in the TMJ area. Twenty-eight healthy subjects (27.4 +/- 6.2 years) without temporomandibular disorders (TMD) participated. The subjects received an AT nerve block (n = 14) or an IA injection (n = 14) with LA (Bupivacaine, 2.5 mg/ml) on one side, and a placebo injection (isotonic saline) on the contralateral side. Mechanical (tactile and pin-prick) and thermal sensitivity (40 and 5 degrees C) were assessed at 11 standardized points in the TMJ area before injections (baseline) as well as 30 min, 1 and 2 h after injections. All stimuli were rated by the subjects on a 0-100 numerical rating scale (NRS). TMJ pressure pain threshold (PPT) and pressure pain tolerance (PPTOL) were assessed laterally over both TMJs using an algometer. IA injections with LA were not associated with any changes in sensitivity of the TMJ or surrounding area. In contrast, AT nerve blocks with LA caused a decrease over time in the pin-prick sensitivity (P = 0.016), which however, did not differ significantly from saline, and an increase of the PPTs 30 min (P = 0.010) and PPTOLs 30 min, 1 h and 2 h (P < 0.05) after LA injections in comparison to saline. No other measures showed a significant change after the injections. Our results showed that IA bupivacaine injection in healthy subjects has no effect on the sensitivity of the TMJ or surrounding area, while AT nerve block has a more pronounced effect on deep mechanical, but not on superficial mechanical or thermal sensitivity. Further research to investigate the effect of LA on somatosensory functions in TMJ patients in comparison with this study results will give valuable information about the sensitivity in the TMJ area.
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Affiliation(s)
- Emad E Ayesh
- Department of Clinical Oral Physiology, School of Dentistry, Aarhus University, Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.
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