mandibular nerve


Summary: A branch of the trigeminal (5th cranial) nerve. The mandibular nerve carries motor fibers to the muscles of mastication and sensory fibers to the teeth and gingivae, the face in the region of the mandible, and parts of the dura.

Top Publications

  1. Malamed S. Is the mandibular nerve block passé?. J Am Dent Assoc. 2011;142 Suppl 3:3S-7S pubmed
    ..The purpose of this supplement to The Journal of the American Dental Association is to determine whether the mandibular nerve block has become passé...
  2. Hashemi H. Neurosensory function following mandibular nerve lateralization for placement of implants. Int J Oral Maxillofac Surg. 2010;39:452-6 pubmed publisher
    ..This prospective cohort study investigates the types and duration of neurosensory disturbances (NDs) related to mandibular nerve (MN) lateralization for placement of implants...
  3. Gerlach N, Meijer G, Maal T, Mulder J, Rangel F, Borstlap W, et al. Reproducibility of 3 different tracing methods based on cone beam computed tomography in determining the anatomical position of the mandibular canal. J Oral Maxillofac Surg. 2010;68:811-7 pubmed publisher
    ..3 mm (SD 0.384) is noted, indicating that a safety zone of 1.7 mm should be respected. When planning surgery on CBCT-based data, surgeons should be aware of the obvious deviations located in the region of the anterior loop of the canal. ..
  4. Piagkou M, Demesticha T, Skandalakis P, Johnson E. Functional anatomy of the mandibular nerve: consequences of nerve injury and entrapment. Clin Anat. 2011;24:143-50 pubmed publisher
    ..structures including bone, muscle, or fibrous bands may entrap and potentially compress branches of the mandibular nerve (MN)...
  5. Terumitsu M, Seo K, Matsuzawa H, Yamazaki M, Kwee I, Nakada T. Morphologic evaluation of the inferior alveolar nerve in patients with sensory disorders by high-resolution 3D volume rendering magnetic resonance neurography on a 3.0-T system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111:95-102 pubmed publisher
    ..The current study clearly demonstrated that appropriate application of clinical MRI techniques can significantly improve the diagnosis and potential treatment of patients with orofacial peripheral nerve disorders. ..
  6. Misch C, Resnik R. Mandibular nerve neurosensory impairment after dental implant surgery: management and protocol. Implant Dent. 2010;19:378-86 pubmed publisher
    ..The most common nerve affected is the mandibular nerve, which may be injured during either implant surgery or bone grafting procedures...
  7. Moore P, Cuddy M, Cooke M, Sokolowski C. Periodontal ligament and intraosseous anesthetic injection techniques: alternatives to mandibular nerve blocks. J Am Dent Assoc. 2011;142 Suppl 3:13S-8S pubmed
    ..Dentists may find these techniques to be useful alternatives to nerve block anesthesia. ..
  8. Nakagawa K, Takeda M, Tsuboi Y, Kondo M, Kitagawa J, Matsumoto S, et al. Alteration of primary afferent activity following inferior alveolar nerve transection in rats. Mol Pain. 2010;6:9 pubmed publisher
  9. Kim T, Caruso J, Christensen H, Torabinejad M. A comparison of cone-beam computed tomography and direct measurement in the examination of the mandibular canal and adjacent structures. J Endod. 2010;36:1191-4 pubmed publisher
    ..Based on the results of this study, the I-CAT Classic can be used to measure distances from the apices of the posterior teeth to the mandibular canal as accurately as direct anatomic dissection. ..

More Information


  1. Mohammadi Z. Endodontics-related paresthesia of the mental and inferior alveolar nerves: an updated review. J Can Dent Assoc. 2010;76:a117 pubmed
    ..The purpose of this paper is to review paresthesia caused by periapical lesions, local anesthesia, cleaning, shaping and obturation...
  2. Yoshioka I, Tanaka T, Khanal A, Habu M, Kito S, Kodama M, et al. Relationship between inferior alveolar nerve canal position at mandibular second molar in patients with prognathism and possible occurrence of neurosensory disturbance after sagittal split ramus osteotomy. J Oral Maxillofac Surg. 2010;68:3022-7 pubmed publisher
    ..Also, the present study evaluated the difference in anatomic position of the IAN between patients with and without mandibular prognathism...
  3. Wadhwani P, Mathur R, Kohli M, Sahu R. Mandibular canal variant: a case report. J Oral Pathol Med. 2008;37:122-4 pubmed publisher
    ..Various types of bifid mandibular canals have been classified according to anatomical location and configuration. This case report highlights an unusual variant of the mandibular canal. ..
  4. Hwang K, Lee W, Song Y, Chung I. Vulnerability of the inferior alveolar nerve and mental nerve during genioplasty: an anatomic study. J Craniofac Surg. 2005;16:10-4; discussion 14 pubmed
    ..4 degrees lateral, 67.2 degrees superior, and 80.2 degrees posterior. It is advisable for surgeons to keep the level of sliding osteotomy of the mentum at least 4.5 mm below the mental foramen to spare the IAN. ..
  5. Hupp J. Legal implications of third molar removal. Oral Maxillofac Surg Clin North Am. 2007;19:129-36, viii pubmed
    ..The next section discusses means of preventing or mitigating the injuries that can occur during or after impaction surgery. The final sections cover various strategies to consider should a problem occur or legal action seem imminent. ..
  6. Fan S, Chen W, Pan C, Huang Z, Xian M, Yang Z, et al. Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108:e89-93 pubmed publisher
    ..None of the observed differences between the 2 groups was significant (P > .05). Both injection combinations resulted in high anesthetic success in patients with irreversible pulpitis in the mandibular first molar. ..
  7. Kohler B, Castellón L, Laissle G. Gow-Gates technique: a pilot study for extraction procedures with clinical evaluation and review. Anesth Prog. 2008;55:2-8 pubmed publisher
    ..The volume of anesthetic solution is indirectly proportional to the onset of complete anesthesia. A premolar-molar extraction can be done, with 3.6 mL of anesthetic solution, in more than 50% of the patients 8 minutes after injection. ..
  8. Chudler E, Anderson L, Byers M. Trigeminal ganglion neuronal activity and glial fibrillary acidic protein immunoreactivity after inferior alveolar nerve crush in the adult rat. Pain. 1997;73:141-9 pubmed
    ..However, the persistence of GFAP-IR 59 days after nerve injury suggests that satellite cell GFAP is involved in the long-term recovery of injured neurons. ..
  9. Claeys V, Wackens G. Bifid mandibular canal: literature review and case report. Dentomaxillofac Radiol. 2005;34:55-8 pubmed
    ..Bifid mandibular canals are often unrecognized. The detection of these anatomical variations is important because of its clinical implications. Special attention has to be paid in surgical procedures involving the lower jaw. ..
  10. Zandi M, Seyedzadeh Sabounchi S. Design and development of a device for facilitation of Gow-Gates mandibular block and evaluation of its efficacy. Oral Maxillofac Surg. 2008;12:149-53 pubmed publisher
  11. Meechan J, Kanaa M, Corbett I, Steen I, Whitworth J. Pulpal anaesthesia for mandibular permanent first molar teeth: a double-blind randomized cross-over trial comparing buccal and buccal plus lingual infiltration injections in volunteers. Int Endod J. 2006;39:764-9 pubmed
    ..90). Lingual injection was more uncomfortable than lingual penetration (P = O.O02). Buccal and buccal plus lingual infiltrations did not differ in their efficacy in producing anaesthesia of permanent first molar teeth. ..
  12. Tilotta Yasukawa F, Millot S, El Haddioui A, Bravetti P, Gaudy J. Labiomandibular paresthesia caused by endodontic treatment: an anatomic and clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:e47-59 pubmed
  13. Hirsch A, Shteiman S, Boyan B, Schwartz Z. Use of orthodontic treatment as an aid to third molar extraction: a method for prevention of mandibular nerve injury and improved periodontal status. J Periodontol. 2003;74:887-92 pubmed
    ..6 mm. The interdisiplinary use of periodontics and orthodontics results in non-surgical removal of impacted mandibular third molars without damage to the inferior alveolar nerve and iatrogenic periodontal sequelae to the second molars. ..
  14. Matthews R, Drum M, Reader A, Nusstein J, Beck M. Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails. J Endod. 2009;35:343-6 pubmed publisher
    ..Unfortunately, the modest success rate would not provide predictable pulpal anesthesia for all patients requiring profound anesthesia. ..
  15. Burstein J, Mastin C, Le B. Avoiding injury to the inferior alveolar nerve by routine use of intraoperative radiographs during implant placement. J Oral Implantol. 2008;34:34-8 pubmed publisher
    ..Using this technique for 21 implants placed in the posterior atrophic mandible, with less than 10 mm of vertical bone to the inferior alveolar nerve canal, the authors observed no incidents of postoperative paresthesia. ..
  16. Daane S, Owsley J. Incidence of cervical branch injury with "marginal mandibular nerve pseudo-paralysis" in patients undergoing face lift. Plast Reconstr Surg. 2003;111:2414-8 pubmed
    ..In the senior author's practice, "pseudoparalysis of the marginal mandibular nerve" due to cervical branch injury occurred in 34 of 2002 superficial musculoaponeurotic system-platysma ..
  17. Essick G, Patel S, Trulsson M. Mechanosensory and thermosensory changes across the border of impaired sensitivity to pinprick after mandibular nerve injury. J Oral Maxillofac Surg. 2002;60:1250-66 pubmed
    ..determine how sensory function varies across the border of impaired sensitivity to pinprick in patients with mandibular nerve injuries...
  18. Dario L. Implant placement above a bifurcated mandibular canal: a case report. Implant Dent. 2002;11:258-61 pubmed
    ..This may or may not be seen on panoramic or periapical films. A case report is presented that uses complex motion tomography as an aid to proper implant placement above a bifurcated mandibular canal. ..
  19. Jabbar S, Harada F, Aita M, Ohishi M, Saito I, Kawano Y, et al. Involvement of neurotrophin-4/5 in regeneration of the periodontal Ruffini endings at the early stage. J Comp Neurol. 2007;501:400-12 pubmed
    ..2003] Arch Histol Cytol 66:183-194), these morphological and numerical data suggest that multiple neurotrophins such as NT-4/5 and brain-derived neurotrophic factor (BDNF) play roles in their regeneration in a stage-specific manner. ..
  20. Davies S, Loescher A, Clayton N, Bountra C, Robinson P, Boissonade F. Changes in sodium channel expression following trigeminal nerve injury. Exp Neurol. 2006;202:207-16 pubmed
    ..As they occur at a time of known high abnormal neural discharge, it seems likely that changes in sodium channel expression may play a role in nerve injury-induced trigeminal pain. ..
  21. Foster W, Drum M, Reader A, Beck M. Anesthetic efficacy of buccal and lingual infiltrations of lidocaine following an inferior alveolar nerve block in mandibular posterior teeth. Anesth Prog. 2007;54:163-9 pubmed
    ..We conclude that adding a buccal or lingual infiltration of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine to an IANB did not significantly increase anesthetic success in mandibular posterior teeth. ..
  22. Naitoh M, Katsumata A, Kubota Y, Hayashi M, Ariji E. Relationship between cancellous bone density and mandibular canal depiction. Implant Dent. 2009;18:112-8 pubmed publisher
    ..The depiction of the mandibular canal in digital panoramic images was related to bone density in the alveolar region. ..
  23. Robinson P, Boissonade F, Loescher A, Smith K, Yates J, Elcock C, et al. Peripheral mechanisms for the initiation of pain following trigeminal nerve injury. J Orofac Pain. 2004;18:287-92 pubmed
    ..These differences will need to be taken into account when developing new therapeutic approaches for the management of injury-induced trigeminal pain. ..
  24. Karamifar K, Shahidi S, Tondari A. Bilateral bifid mandibular canal: report of two cases. Indian J Dent Res. 2009;20:235-7 pubmed publisher
    ..Therefore, awareness of this condition is important. We report two cases of bilateral bifid mandibular canal: one in a 22-year-old male and the other in a 24-year-old female. ..
  25. Stein P, Brueckner J, Milliner M. Sensory innervation of mandibular teeth by the nerve to the mylohyoid: implications in local anesthesia. Clin Anat. 2007;20:591-5 pubmed
    ..This review provides a background of anatomical and clinical research of the nerve to the mylohyoid and outlines techniques suggested for providing a neural blockade of the nerve to the mylohyoid. ..
  26. Bundy M, Cavola C, Dodson T. Panoramic radiographic findings as predictors of mandibular nerve exposure following third molar extraction: digital versus conventional radiographic techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:e36-40 pubmed publisher
    The aim was to compare digital and conventional panoramic imaging techniques for identifying high-risk radiographic markers associated with mandibular nerve (MN) injury after mandibular third molar (M3) removal.
  27. Saito K, Hitomi S, Suzuki I, Masuda Y, Kitagawa J, Tsuboi Y, et al. Modulation of trigeminal spinal subnucleus caudalis neuronal activity following regeneration of transected inferior alveolar nerve in rats. J Neurophysiol. 2008;99:2251-63 pubmed publisher
    ..These findings suggest that these alterations may be involved in the development of mechanical allodynia in the cutaneous region innervated by the regenerated IAN. ..
  28. Madan G, Madan S, Madan A. Failure of inferior alveolar nerve block: exploring the alternatives. J Am Dent Assoc. 2002;133:843-6 pubmed
    ..Practice Implications. Mastering anesthetic techniques maximizes success in the dental office. It enables clinicians to provide better and more comfortable treatment to patients. ..
  29. Scolozzi P, Lombardi T, Jaques B. Successful inferior alveolar nerve decompression for dysesthesia following endodontic treatment: report of 4 cases treated by mandibular sagittal osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004;97:625-31 pubmed
    ..All the patients experienced immediate relief of dysesthesia and paresthesia. ..
  30. Steinkruger G, Nusstein J, Reader A, Beck M, Weaver J. The significance of needle bevel orientation in achieving a successful inferior alveolar nerve block. J Am Dent Assoc. 2006;137:1685-91 pubmed
    ..For IAN blocks administered with a 27-gauge needle, positioning the needle bevel away or toward the mandibular ramus does not affect anesthetic success. ..
  31. Dempf R, Hausamen J. Lesions of the inferior alveolar nerve arising from endodontic treatment. Aust Endod J. 2000;26:67-71 pubmed
    ..If the filling material is forced directly within the endoneurium between the nerve bundles, the damaged nerve sections must be resected and bridged using transplants from the sural or greater auricular nerves...
  32. Sanchis J, Penarrocha M, Soler F. Bifid mandibular canal. J Oral Maxillofac Surg. 2003;61:422-4 pubmed
    ..In this study, 0.35% of canals were bifid. All cases were in women. ..
  33. Giuliani M, Lajolo C, Deli G, Silveri C. Inferior alveolar nerve paresthesia caused by endodontic pathosis: a case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:670-4 pubmed
    ..31) may have been the cause. The routine x-rays (intraoral and panorex) and the axial and cross-sectional tomographs of the mandible by means of computed tomography contribute to making this case a good example of nerve injury. ..
  34. Ghaeminia H, Meijer G, Soehardi A, Borstlap W, Mulder J, Berge S. Position of the impacted third molar in relation to the mandibular canal. Diagnostic accuracy of cone beam computed tomography compared with panoramic radiography. Int J Oral Maxillofac Surg. 2009;38:964-71 pubmed publisher
    ..This observation dictates the surgical approach how to remove the third molar, so the IAN will not be subjected to pressure...
  35. Simonton J, Azevedo B, Schindler W, Hargreaves K. Age- and gender-related differences in the position of the inferior alveolar nerve by using cone beam computed tomography. J Endod. 2009;35:944-9 pubmed publisher
    ..01). Collectively, these data indicate that both gender and age are predictive of surgical endodontic anatomic relationships and should be considered in presurgical planning. ..
  36. Angelopoulos C, Thomas S, Thomas S, Hechler S, Hechler S, Parissis N, et al. Comparison between digital panoramic radiography and cone-beam computed tomography for the identification of the mandibular canal as part of presurgical dental implant assessment. J Oral Maxillofac Surg. 2008;66:2130-5 pubmed publisher
    ..This may result in very clear images that better depict the mandibular canal. ..
  37. Goldberg S, Reader A, Drum M, Nusstein J, Beck M. Comparison of the anesthetic efficacy of the conventional inferior alveolar, Gow-Gates, and Vazirani-Akinosi techniques. J Endod. 2008;34:1306-1311 pubmed publisher
  38. Palm A, Kirkegaard U, Poulsen S. The wand versus traditional injection for mandibular nerve block in children and adolescents: perceived pain and time of onset. Pediatr Dent. 2004;26:481-4 pubmed
    ..No difference could be found in time of onset between the 2 methods. Mandibular alveolar block analgesia seems to be less painful when using The Wand than when using a traditional syringe. ..
  39. Suazo Galdames I, Cantín López M, Zavando Matamala D. Inferior alveolar nerve block anesthesia via the retromolar triangle, an alternative for patients with blood dyscrasias. Med Oral Patol Oral Cir Bucal. 2008;13:E43-7 pubmed
    ..The proposed technique, even when it proved to be less effective than the Spix technique, can be seen as a lower risk alternative for patients carrying blood dyscrasias and being subjected to dental procedures in mandibular teeth. ..
  40. Naftel J, Richards L, Pan M, Bernanke J. Course and composition of the nerves that supply the mandibular teeth of the rat. Anat Rec. 1999;256:433-47 pubmed
    ..This detailed information on the courses taken by the dental nerves can provide an anatomical basis for increased precision in characterization and perturbation of neural pathways from the molars and incisor. ..
  41. Aggarwal V, Jain A, Kabi D. Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis. J Endod. 2009;35:925-9 pubmed publisher
  42. Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, et al. A comparative study of cone-beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:253-9 pubmed
    ..Cone-beam CT was significantly superior to panoramic images in predicting neurovascular bundle exposure during extraction of impacted mandibular third molar teeth. ..
  43. Iwata K, Imai T, Tsuboi Y, Tashiro A, Ogawa A, Morimoto T, et al. Alteration of medullary dorsal horn neuronal activity following inferior alveolar nerve transection in rats. J Neurophysiol. 2001;86:2868-77 pubmed
  44. Levine M, Goddard A, Dodson T. Inferior alveolar nerve canal position: a clinical and radiographic study. J Oral Maxillofac Surg. 2007;65:470-4 pubmed
    ..To minimize the risk of IAN injury, these variables should be considered when planning mandibular osteotomies or using monocortical plates. ..
  45. Mostafeezur R, Yamamura K, Kurose M, Yamada Y. Mastication-induced modulation of the jaw-opening reflex during different periods of mastication in awake rabbits. Brain Res. 2009;1254:28-37 pubmed publisher
    ..Sensory inputs from both the chewing and non-chewing sides similarly regulate the activity of the jaw-opening muscles...
  46. Nomura H, Ogawa A, Tashiro A, Morimoto T, Hu J, Iwata K. Induction of Fos protein-like immunoreactivity in the trigeminal spinal nucleus caudalis and upper cervical cord following noxious and non-noxious mechanical stimulation of the whisker pad of the rat with an inferior alveolar nerve transection. Pain. 2002;95:225-38 pubmed
  47. Auluck A, Pai K, Mupparapu M. Multiple mandibular nerve canals: radiographic observations and clinical relevance. Report of 6 cases. Quintessence Int. 2007;38:781-7 pubmed
    Variation in the normal anatomic pattern of the inferior alveolar nerve canal such as bifid or trifid mandibular nerve canal is one of the reasons for local anesthetic failure in dental practice...
  48. Vazquez L, Saulacic N, Belser U, Bernard J. Efficacy of panoramic radiographs in the preoperative planning of posterior mandibular implants: a prospective clinical study of 1527 consecutively treated patients. Clin Oral Implants Res. 2008;19:81-5 pubmed
  49. Escoda Francoli J, Canalda Sahli C, Soler A, Figueiredo R, Gay Escoda C. Inferior alveolar nerve damage because of overextended endodontic material: a problem of sealer cement biocompatibility?. J Endod. 2007;33:1484-9 pubmed
  50. Tsuboi Y, Takeda M, Tanimoto T, Ikeda M, Matsumoto S, Kitagawa J, et al. Alteration of the second branch of the trigeminal nerve activity following inferior alveolar nerve transection in rats. Pain. 2004;111:323-34 pubmed
  51. Iwata K, Tsuboi Y, Shima A, Harada T, Ren K, Kanda K, et al. Central neuronal changes after nerve injury: neuroplastic influences of injury and aging. J Orofac Pain. 2004;18:293-8 pubmed
    ..These observations suggest that the changes in neuronal activity in the aged rats likely corresponded to the changes observed in the rat model of peripheral nerve injury. ..
  52. Lofthag Hansen S, Grondahl K, Ekestubbe A. Cone-beam CT for preoperative implant planning in the posterior mandible: visibility of anatomic landmarks. Clin Implant Dent Relat Res. 2009;11:246-55 pubmed publisher
    ..Hence, the 3D Accuitomo can be recommended for implant planning in the posterior mandible. ..
  53. Kamburoglu K, Kilic C, Ozen T, Yuksel S. Measurements of mandibular canal region obtained by cone-beam computed tomography: a cadaveric study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:e34-42 pubmed publisher
    ..61 to 0.93 for the first observer and from 0.40 to 0.95 for the second observer. Accuracy of cone-beam CT measurements of various distances surrounding the mandibular canal was comparable to that of digital caliper measurements. ..