An extraordinary variation in origin of inferior alveolar nerve and its clinical significance: a case report
DOI:
https://doi.org/10.18203/2320-6012.ijrms20173021Keywords:
Infratemporal fossa, Inferior alveolar nerve, Mandibular nerve, Maxillary arteryAbstract
Infratemporal fossa is a clinically significant site for delivery of local anaesthesia during dental procedures and maxillofacial surgeries. An extraordinary variation involving formation of inferior alveolar nerve was revealed during routine dissection of infra temporal region for teaching undergraduate medical students. Inferior alveolar nerve was seen to be incongruously originating from two separate roots from the posterior division of mandibular nerve. Furthermore, these two roots of inferior alveolar nerve were divulging unusual relationship with the maxillary artery. Superficial root of inferior alveolar nerve was coursing superficial to second part of maxillary artery and deep root was found to be emerging posterior to this part of maxillary artery. Additionally, deep root was sending a well-defined twig which when traced was found to be communicating with Lingual nerve. This unusual type of variation of Inferior alveolar nerve in this region may result in atypical symptoms of pain, numbness, headaches, interfere with outcome of injection of local anaesthesia and even surgical interventions in the infratemporal fossa.
References
Reynolds PA. Infratemporal and pterygopalatine fossae and tempero mandibular joint. In: Susan Standring, Neil R Borley, Patricia Collins, Allan R Crossman, eds. Gray’s Anatomy. 40th ed. Churchill Livingstone London; 2008:542-543.
Dodd GD, Dolan PA, Ballantyne AJ, Ibanez ML, Chau P. The dissemination of tumours of head and neck via the cranial nerves. Radiol Clin North America. 1970;8:445-61.
Racz VL, Manos T. Anatomical variants of lingual nerve in human. Anat Anz. 1981;149:64-71.
Babu PB, Bhat KR, Nayak VS. Perforation of inferior alveolar nerve by maxillary artery. Rev Arg De Anat Clin. 2011;3(3):124-9.
Wolfe KT, Brokaw EJ, Bell A, Joy A. Variant inferior alveolar nerves and implications for local anesthesia. Anesth Prog. 2016;63(2):84-90.
Xang M. Neck. In: Standring S, Johnson D, Collins P, Mahadevan V, eds. Gray s anatomy. 40th ed. Churchill Livingstone, London; 2008:446-447.
The temporal and infratemporal regions. Romanes GJ, ed. Cunninghams manual of practical anatomy,15th ed. Oxford,New York; 2011:118-126.
Roy TS, Sarkar AK, Panicker HK. Variation in the Origin of the Inferior Alveolar Nerve. Clin Anatomy. 2002;15:143-7.
Babu PB, Bhat KR, Nayak VS. Perforation of inferior alveolar nerve by maxillary artery. Rev Arg De Anat Clin. 2011;3(3):124-29.
Sharma A, Vohra H, Singh P, Sood V. Unusual origin and variation in topographical relation of inferior alveolar nerve in the left infratemporal region. J Indian Med Assoc. 2011;109(2): 96-8.
Khan MM, Darwish HH, Zaher WA. Perforation of the inferior alveolar nerve by the maxillary artery: an anatomical study. Br J Oral Maxillofacial Surg. 2010;48(8):645.
Pai MM, Swamy RS, Prabhu LV. A variation in morphology of the inferior alveolar nerve with potential clinical significance. Biomed International. 2010;1:93-5.
Pretterklieber ML, Skopakoff C, Mayr R. The human maxillary artery reinvestigated: I. Topographical relations in the infratemporal fossa. Acta Anat. 1991;142(4):281-7.
Ortug VG, Moriggl B. Studies about the topography of the maxillary artery within the infratemporal fossa. Anat Anz. 1991;172(3):197-202.
Khaledpour C. An anatomic variant of the inferior alveolar nerve in man. Anat Anz. 1984;156(5):403-6.
Anil A, Peket T, Turgut HB, Gulekon IN. Variation in anatomy of inferior alveolar nerve. Br J Oral Maxillofacial Sur.2003;41(4):236-39.
Krampotic-Nemanic J, Vinter I, Hat J, Jalsovec D. Mandibular neuralgia due to anatomical variations. Eur Arch Otorhinolaryngol. 1999;256(4):205-8.
Calvin WH, Loeser JD, Howe JF. A neurophysiological theory for the pain mechanism of tic douloureux. Pain. 1977;3(2):147-54.
Bronner-Fraser M. Environmental influences on neural crest cell migration. J Neurobiol. 1993;24(2):233-47.
Ranscht B, Bronner-Fraser M. T-cadherin expression alternates with migrating neural crest cells in the trunk of the avian embryo. Development. 1991;111(1):15-22.
Debby-Brafman A, Burstyn-Cohen T, Klar A, Kalcheim C. F-Spondin, expressed in somite regions avoided by neural crest cells, mediates inhibition of distinct somite domains to neural crest migration. Neuron. 1999;22(3):475-88.
