An Atypical Path of the Lingual Nerve in the Retromolar Region: Incidence in Oral Surgery
The Lingual nerve is frequently anesthetized during oral, maxillofacial, or otorhinolaryngology surgery. It originates below the oval hole in the infratemporal region, follows its path down and forward, and moves away from the medial surface of the ramus. From there, it goes just above the mylohyoid line. It approaches the lateral margin of the tongue and crosses the Wharton's canal, and divides into numerous branches. Some cases of temporomandibular joint syndrome or myofascial pain syndrome could be a result of its anatomical variations. Also, the jurisprudence has always condemned the practitioner if for not demonstrating that the path of the injured nerve presents an anomaly which makes his involvement inevitable. The purpose is to present one of the multiple atypical paths of the lingual nerve not described in the retromandibular trigone, demonstrating that its damage constitutes a risk that cannot be controlled.
On a cadaver dissection, the yellow arrow shows the lingual nerve (LN) going towards the retromolar region instead of going directly towards the tongue.
Highlighting of an atypical course of the lingual nerve. The yellow arrow shows that before continuing its journey towards the tongue, the NL gives a collateral (a branch) which enters a retromolar foramen.
The difference between a normal LN path (right) and the atypical path (left); described in the dissection. The red arrow indicates a branch of the LN that enters the retromolar foramen (left) instead of the lingual nerve going directly to the tongue as in the normal case (right).
Contributor Notes