Supplemental Innervation of the Mandible and it ́s Clinical Implications. Narrative Review

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Selman Cárdenas, Carlos & Soto, Reinaldo


Under normal conditions, the mandible and its anatomical structures (teeth, muscles, skin) are innervated by the branches of the third division of the trigeminal nerve (mandibular nerve), however, there are reports that show supplementary innervation of the lower teeth and the mandibular angle area. The latter could be responsible for the failure of the nerve block under local anesthesia. The main objective of this research; is to review articles that describe the participation of other nerves such as the mylohyoid nerve, and the superficial branches of the cervical plexus, which can enter the mandible through foramina located along its architecture. For this, a narrative review of the scientific literature was carried out, in English and Spanish, from 1971 to 2019, using the digital platforms PubMed, EBSCO, Cochrane library, Scielo and Google Scholar, gray literature and in addition to a search Handbook. According to the results of the review, the existence of the failures of the mandibular anesthetic techniques due to the accessory innervation of the mandible and the lower teeth is confirmed, where the three main nerves reviewed have an impact on this postulate. In conclusion, an order of execution is proposed to perform local anesthetic infiltration into the jaw to achieve a successful block during dental procedures that require it.

KEY WORDS: Failure anesthesia; Mylohyoid nerve; Supplementary innervation; Cervical plexus; Mandible.

How to cite this article

SELMAN, C. C. & SOTO, R. Supplemental innervation of the mandible and it ́s clinical implications. Narrative review. Int. J. Morphol., 40(4):973-980, 2022.