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Mandibular nerve entrapment in the infratemporal fossa

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Abstract

The posterior trunk of the mandibular nerve (V3) comprises of three main branches. Various anatomic structures may entrap and potentially compress the mandibular nerve branches. A usual position of mandibular nerve (MN) compression is the infratemporal fossa (ITF) which is one of the most difficult regions of the skull base to access surgically. The anatomical positions of compression are: the incomplete or complete ossified pterygospinous (LPs) or pterygoalar (LPa) ligament, the large lamina of the lateral plate of the pterygoid process and the medial fibres of the lower belly of the lateral pterygoid (LPt). A contraction of the LPt, due to the connection between nerve and anatomic structures (soft and hard tissues), might lead to MN compression. Any variations of the course of the MN branches can be of practical significance to surgeons and neurologists who are dealing with this region, because of possibly significant complications. The entrapment of the MN motor branches can lead to paresis or weakness in the innervated muscle. Compression of the sensory branches can provoke neuralgia or paraesthesia. Lingual nerve (LN) compression causes numbness, hypoesthesia or even anaesthesia of the mucous of the tongue, anaesthesia and loss of taste in the anterior two-thirds of the tongue, anaesthesia of the lingual gums, as well as pain related to speech articulation disorders. Dentists should be very suspicious of possible signs of neurovascular compression in the region of the ITF.

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References

  1. Akita K, Shimokawa T, Sato T (2000) Positional relationships between the masticatory muscles and their innervating nerves with special reference to the lateral pterygoid and the midmedial and discotemporal muscle bundles of temporalis. J Anat 197:291–302

    Article  PubMed  Google Scholar 

  2. Akita K, Shimokawa T, Sato T (2001) Aberrant muscle between the temporalis and the lateral pterygoid muscles: M. pterygoideus proprius (Henle). Clin Anat 14:288–291

    Article  PubMed  CAS  Google Scholar 

  3. Anil A, Peker T, Turgut HB, Gulekon IN, Liman F (2003) Variations in the anatomy of the inferior alveolar nerve. Br J Oral Maxillofac Surg 41:236–239

    Article  PubMed  CAS  Google Scholar 

  4. Antonopoulou M, Piagkou M, Anagnostopoulou S (2008) An anatomical study of the pterygospinous and pterygoalar bars and foramina—their clinical relevance. J Cranio-Maxillofac Surg 36:104–108

    Article  Google Scholar 

  5. Chouke KS (1946) On the incidence of the foramen of Civinini and the porus crotaphiticobuccinatorius in American Whites and Negroes: I. Observations on 1544 skulls. Am J Phys Anthropol 4:203–225

    Article  PubMed  CAS  Google Scholar 

  6. Chouke KS (1947) On the incidence of the foramen of Civinini and the porus crotaphitico-buccinatorius in American Whites and Negroes: II. Observations on 2745 additional skulls. Am J Phys Anthropol 5:79–86

    Article  PubMed  CAS  Google Scholar 

  7. Chouke KS (1949) Injection of mandibular nerve and gasserian ganglion: an anatomic study. Am J Surg 78:80–85

    Article  PubMed  CAS  Google Scholar 

  8. Chouke KS, Hodes PJ (1951) The pterygoalar bar and its recognition by roentgen methods in trigeminal neuralgia. Am J Roentgenol 65:180–182

    CAS  Google Scholar 

  9. Civinini F (1835) Varieta non commune dell’ osso sfenoido umano. Nuovo Gior de’ letterati di Pisa 31:39–43 (as cited by Tebo HG 1968)

  10. Das S, Paul S (2007) Ossified pterygospinous ligament and its clinical implications. Bratisl Lek Listy 108:141–143

    PubMed  Google Scholar 

  11. De Froe, Wagennar JH (1935) Die Bedeutung des porus crotaphitico-buccinatorius and des Foramen pterygospinosum fur Neurologic and Rontgenologic

  12. Gray’s Anatomy (1995) Churchill Livingstone, New York, 28th edn, pp 380–381

  13. Hyrtl J (1862) Uber den porus crotaphitico-buccinatorius beim Menschen, Sitzungsb. Kaiserl. Akad Wissensch. Wien, Natur- mathem. Klasse 46:111–115

    Google Scholar 

  14. Isberg AM, Isacsson G, Williams WN, Loughner BA (1987) Lingual numbness and speech articulation deviation associated with temporomandibular joint disk displacement. Oral Surg Oral Med Oral Pathol 64:9–14

    Article  PubMed  CAS  Google Scholar 

  15. Johansson AS, Isberg A, Isacsson G (1990) A radiographic and histologic study of the topographic relations in the temporomandibular joint region: implications for a nerve entrapment mechanism. J Oral Maxillofac Surg 48:953–961

    Article  PubMed  CAS  Google Scholar 

  16. Kapur E, Dilberovic F, Redzepagic S, Berhamovic E (2000) Variation in the lateral plate of the pterygoid process and the lateral subzygomatic approach to the mandibular nerve. Med Arh 54:133–137

    PubMed  CAS  Google Scholar 

  17. Khan MM, Darwish HH, Zaher WA (2009) Perforation of the inferior alveolar nerve by the maxillary artery: an anatomical study. Br J Oral Maxillofac Surg (in press)

  18. Kim HJ, Kwak HH, Hu KS, Park HD, Kang HC, Jung HS, Koh KS (2003) Topographic anatomy of the mandibular nerve branches distributed on the two heads of the lateral pterygoid. Int J Oral Maxillofac Surg 32:408–413

    Article  PubMed  CAS  Google Scholar 

  19. Kim SY, Hu KS, Chung IH, Lee EW, Kim HJ (2004) Topographic anatomy of the lingual nerve and variations in communication pattern of the mandibular nerve branches. Surg Radiol Anat 26:128–135

    Article  PubMed  CAS  Google Scholar 

  20. Krmpotic-Nemanic J, Vinter J, Jalsovec D (2001) Accessory oval foramen. Ann Anat 183:293–295

    Article  PubMed  CAS  Google Scholar 

  21. Krmpotic-Nemanic J, Vinter I, Hat J, Jalsovec D (1999) Mandibular neuralgia due to anatomical variations. Eur Arch Otorhinolaryngol 256:205–208

    Article  PubMed  CAS  Google Scholar 

  22. Kwak HH, Ko SJ, Jung HS, Park HD, Chung IH, Kim HJ (2003) Topographic anatomy of the deep temporal nerves, with references to the superior head of lateral pterygoid. Surg Radiol Anat 25:393–399

    Article  PubMed  CAS  Google Scholar 

  23. Lang J (1995) Skull base and related structures—atlas of clinical anatomy. Stuttgart, Schattauer; pp 55–57, 300–311

  24. Lang J, Hetterich A (1983) Contribution on the postnatal development of the processus pterygoideus. Anat ANZ 154:1–31

    PubMed  CAS  Google Scholar 

  25. Lepp FH, Sandner O (1968) Anatomic-radiographic study of ossified pterygospinous and ‘innominate’ ligaments. Oral Surg Oral Med Oral Pathol 26:244–260

    Article  PubMed  CAS  Google Scholar 

  26. Loughner BA, Larkin LH, Mahan PE (1990) Nerve entrapment in the lateral pterygoid muscle. Oral Surg Oral Med Oral Pathol 69:299–306

    Article  PubMed  CAS  Google Scholar 

  27. Madhavi C, Issac B, Jacob TM (2006) Variation of the middle deep temporal nerve: a case report. Eur J Anat 10:157–160

    Google Scholar 

  28. Nayak SR, Rai R, Krishnamurthy A, Prabhu LV, Ranade AV, Mansur DI, Kumar S (2008) An unusual course and entrapment of the lingual nerve in the infratemporal fossa. Bratisl Lek Listy 109:525–527

    PubMed  Google Scholar 

  29. Nayak SR, Saralaya V, Prabhu LV, Pai MM, Vadgaonkar R, D’Costa S (2007) Pterygospinous bar and foramina in Indian skulls: incidence and phylogenetic significance. Surg Radiol Anat 29:5–7

    Article  PubMed  Google Scholar 

  30. Ozdogmus O, Saka E, Tulay C, Gurdal E, Uzun I, Cavdar S (2003) The anatomy of the carotico-clinoid foramen and its relation with the internal carotid artery. Surg Radiol Anat 25:241–246

    Article  PubMed  CAS  Google Scholar 

  31. Peker T, Karakose M, Anil A, Turgut HB, Gulekon N (2002) The incidence of basal sphenoid bony bridges in dried crania and cadavers: their anthropological and clinical relevance. Eur J Morphol 40:171–180

    Article  PubMed  CAS  Google Scholar 

  32. Peuker ET, Fischer G, Filler TJ (2001) Entrapment of the lingual nerve due to an ossified pterygospinous ligament. Clin Anat 14:282–284

    Article  PubMed  CAS  Google Scholar 

  33. Pinar Y, Arsu G, Aktan Ikiz ZA, Bilge O (2004) Pterygospinous and pterygoalar bridges. Sendrom 16:66–69

    Google Scholar 

  34. Prades JM, Timishenko A, Merzougui N (2003) A cadaveric study of a combined trans-mandibular and trans-zygomatic approach to the infratemporal fossa. Surg Radiol Anat 25:180–187

    Article  PubMed  Google Scholar 

  35. Priman J, Etter LE (1959) The pterygospinous and pterygoalar bars. Med Radiol Photogr 35:2–9

    CAS  Google Scholar 

  36. Rusu MC, Nimigean V, Podoleanu L, Ivascu RV, Niculesku MC (2008) Details of the intralingual topography and morphology of the lingual nerve. Int J Oral Maxillofac Surg (in press)

  37. Sakamoto Y, Akita K (2004) Spatial relationships between masticatory muscles and their innervating nerves in man with special reference to the medial pterygoid muscle and its accessory muscle bundle. Surg Radiol Anat 26:122–127

    Article  PubMed  CAS  Google Scholar 

  38. Shaw JP (1993) Pterygospinous and pterygoalar foramina: a role in the etiology of trigeminal neuralgia? Clin Anat 6:173–178

    Article  Google Scholar 

  39. Shimokawa T, Akita K, Sato T, Ru F, Yi SQ, Tanaka S (2004) Penetration of muscles by branches of the mandibular nerve: a possible cause of neuropathy. Clin Anat 17:2–5

    Article  PubMed  Google Scholar 

  40. Shimokawa T, Akita K, Soma K, Sato T (1998) Innervation analysis of the small muscle bundles attached to the temporalis: truly new muscles or merely derivatives of the temporalis? Surg Radiol Anat 20:329–334

    Article  PubMed  CAS  Google Scholar 

  41. Skrzat J, Walocha J, Srodek R (2005) An anatomical study of the pterygoalar bar and the pterygoalar foramen. Folia Morphol 64:92–96

    Google Scholar 

  42. Skrzat J, Walocka J, Srodek R, Nizankowska A (2006) An atypical position of the foramen ovale. Folia Morphol 65:396–399

    CAS  Google Scholar 

  43. Soni S, Rath G, Suri R, Vollala VR (2009) Unusual organization of auriculotemporal nerve and its clinical implications. J Oral Maxillofac Surg 67:448–450

    Article  PubMed  Google Scholar 

  44. Sunderland S (1938–1939) A note of the variations of the foramen ovale. ANZ J Surg 8:170–175

    Google Scholar 

  45. Sunderland S (1991) Nerve injuries and their repair: a critical appraisal. Churchill Livingstone, New York, pp 129–146

    Google Scholar 

  46. Sutherland S (1978) Nerves and nerve injuries. Churchill Livingstone, New York, pp 343–350

    Google Scholar 

  47. Tebo HG (1968) The pterygospinous bar in panoramic roentgenography. Oral Surg Oral Med Oral Pathol 26:654–657

    Article  PubMed  CAS  Google Scholar 

  48. Trost O, Kazemi A, Cheynel N, Benkhadra M, Soichot P, Malka G, Trouilloud P (2009) Spatial relationships between lingual nerve and mandibular ramus: original study method, clinical and educational applications. Surg Radiol Anat 31:447–452

    Article  PubMed  Google Scholar 

  49. Von Ludinghausen M, Kageyama I, Miura M, Al Khatib M (2006) Morphological peculiarities on the deep infratemporal fossa in advanced age. Surg Radiol Anat 28:284–292

    Article  Google Scholar 

  50. Wood Jones F (1931) The non-metrical morphological characters of the skulls as criteria for racial diagnosis: Part Ι. General discussion of the morphological characters employed in racial diagnosis. J Anat 65:180–195

    Google Scholar 

  51. Yoshimasu F, Kurland LT, Elveback LR (1972) Tic douloureux in Rochester, Minnesota, 1945–1969. Neurology 22:952–956

    PubMed  CAS  Google Scholar 

  52. Zakrzewska JM (1990) Medical management of trigeminal neuralgia. Br Dent J 168:399–401

    Article  PubMed  CAS  Google Scholar 

  53. Zur KB, Mu L, Sanders I (2004) Distribution pattern of the human lingual nerve. Clin Anat 17:88–92

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Author notes

  1. Maria N. Piagkou & G. Piagkos

    Present address: , 9 Kontoyiannaki Street, 11526, Athens, Greece

  2. G. Androutsos

    Present address: , 1 Ipeirou Street, 10433, Athens, Greece

  3. P. Skandalakis

    Present address: , 19 Kanari Street, 10673, Athens, Greece

Authors and Affiliations

  1. Department of Anatomy, School of Medicine, University of Athens, 75 M. Assias Street, Goudi, 11527, Athens, Greece

    Maria N. Piagkou, G. Piagkos & P. Skandalakis

  2. Department of Anesthesiology, Metropolitan Hospital, 9 Ethnarhou Makariou Street, 18547, Neo Faliro, Greece

    T. Demesticha

  3. Department of History of Medicine, School of Medicine, University of Athens, 75 M. Assias Street, Goudi, 11527, Athens, Greece

    G. Androutsos

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  1. Maria N. Piagkou
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Correspondence to Maria N. Piagkou.

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Piagkou, M.N., Demesticha, T., Piagkos, G. et al. Mandibular nerve entrapment in the infratemporal fossa. Surg Radiol Anat 33, 291–299 (2011). https://doi.org/10.1007/s00276-010-0706-5

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