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How to avoid iatrogenic lingual nerve injury in the retromolar area: an anatomical study of retromolar pad and lingual nerve

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Abstract

Purpose

This study aimed to investigate the relationship between the retromolar gland and pad, and the relationship between the LN and retromolar gland/pad to establish a new landmark for avoiding LN injury.

Methods

Sixty-two lingual nerves from fresh-frozen cadavers were used for this study. The age of the specimens at the time of death ranged from 57 to 98 with a mean of 76.5 years. The mucous incision was made into the medial border of the retromolar pad and the submucosal tissue depth of the initial incision was bluntly dissected to expose the lingual nerve. When the LN was identified, the mucosa overlying the retromolar pad was removed to expose the retromolar gland to confirm if the retromolar pad corresponds to the retromolar gland.

Results

On all sides, the lingual nerve was found to course medial to the retromolar pad and inferior to the inferior border of the superior pharyngeal constrictor muscle to enter the sublingual space via the pterygomandibular space. The retromolar pad corresponded to the retromolar gland on all sides. This demonstrated that the retromolar pad is an overlying mucosa of the retromolar gland. No LN was found to travel through the retromolar gland.

Conclusion

We suggest that the retromolar pad can be used as a new landmark for avoiding iatrogenic LN injury.

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Acknowledgements

The authors would like to thank those who donated their body for the advancement of medical education and research. All the authors have read the manuscript and have approved of this submission.

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Authors and Affiliations

  1. Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA

    Joe Iwanaga & R. Shane Tubbs

  2. Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, 830-0011, Japan

    Joe Iwanaga

  3. Auburn University, Auburn, AL, 36849, USA

    Mary Katherine Cleveland

  4. Section of Removable Partial Prosthodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, 113-8510, Japan

    Junichiro Wada

  5. Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada

    R. Shane Tubbs

  6. Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, 70112, USA

    R. Shane Tubbs

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  1. Joe Iwanaga
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  2. Mary Katherine Cleveland
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  3. Junichiro Wada
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  4. R. Shane Tubbs
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Contributions

JI: protocol/project development, data collection, data analysis, and manuscript writing. MKC: data analysis and manuscript writing. JW: protocol/project development and manuscript writing. RST: protocol/project development, data collection, and manuscript editing.

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Correspondence to Joe Iwanaga.

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The authors received no funding or grants for this work from any organization or foundation. The authors declare that they have no conflicts of interest.

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Iwanaga, J., Cleveland, M.K., Wada, J. et al. How to avoid iatrogenic lingual nerve injury in the retromolar area: an anatomical study of retromolar pad and lingual nerve. Surg Radiol Anat 42, 523–528 (2020). https://doi.org/10.1007/s00276-020-02422-w

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  • DOI: https://doi.org/10.1007/s00276-020-02422-w

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