Surgical Anatomy of Mandible: Department of Oral and Maxilofacial Surgery

DEPARTMENT OF ORAL AND MAXILOFACIAL SURGERY
SURGICAL
ANATOMY OF
MANDIBLE
SUBMITTED BY
SAMEENA SHAMSUDEEN
I MDS
largest and
strongest
bone of the face,
serves for the
reception of the lower
teeth.
curved, horizontal
portion, the body,
and two perpendicular
portions, the rami,
which unite with the
ends of the body
nearly at right angles.
RAMUS
BODY
ANATOMY OF MANDIBLE
MANDIBULAR
NOTCH
CORONOID
PROCSS
ALVOLAR PROCESS
BUCCAL
SHELF
AREA
AR
L
Y
ND S
O
C
CS
O
PR
ANGLE
OF MANDIBLE
EXTERNAL
OBLIQU E
RIDGE
MENTAL
FORAMN
LINGULA
I
YO
H
O
L NE
E
I
MY L
MANDIBULAR
FORAMEN
DEVELOPMENT OF MANDIBLE
By around the
4th week of
intra-uterine
life, five
branchial
arches form in
the region of
the future
head &neck.
E
H
T
F
O
Y
D
E
O
L
B
B
I
E
D
H
N
T
A
M
The mandible is ossified in the fibrous membrane covering

the outer surfaces of Meckel's cartilages.
These cartilages form the cartilaginous bar of the

mandibular arch and are two in number, a right and a
left.
Meckels cartilage
has a close,
relationship to the
mandibular nerve,
at the junction
between posterior
and middle thirds,
where the mandibular nerve

divides into the lingual and
inferior dental nerve.
The lingual nerve passes

forward, on the medial
side of the cartilage,
while the inferior dental
lies lateral to its upper
margins & runs forward
parallel to it and
terminates by dividing
into the mental and
incisive branches.
From the proximal end

of each cartilage the
malleus and
, incus
two of
the
bones
of
the
middle
ear,
are
developed; the next
succeeding portion, as
far as the lingula, is
replaced
by
fibrous
tissue, which persists
to
form
the
sphenomandibular
ligament
&
the
perichondrium of the
Between the lingula and the canine

tooth the cartilage disappears,
while the portion of it below and
behind the incisor teeth becomes
ossified and incorporated with this
part of the mandible.
The mandible first

appears as a band of
dense fibro cellular
tissue which lies on
the lateral side of the
inferior dental and
incisive nerves.
For each half of the mandible, Ossification takes

place in the membrane covering the outer surface
of Meckel's cartilage and each half of the bone
is formed from a single center which appears, in
the region of the bifurcation of the mental and
incisive branches, about the sixth wk of fetal life.
Ossification grows medially below the incisive

nerve and then spread upwards between this nerve
and Meckels cartilage and so the incisive nerve is
contained in a trough or a groove of bone formed
by the lateral and medial plates which are united
beneath the nerve.
At the same stage the notch containing the

incisive nerve extends ventrally around the
mental nerve to form the mental foramen. Also
the bony trough grow rapidly forwards towards
the middle line where it comes into close
relationship with the similar bone of the opposite
side, but from which it is separated by
connective tissue.
A similar spread of ossification in the

backward direction produces at first a trough
of bone in which lies the inferior dental nerve
and much later the mandibular canal is
formed. The ossification stops at the site of
future lingula. By these processes of growth
the original primary center ossification
produces the body of the mandible.
THE R
AMI O
F THE
MAND
IBLE
The ramus of the

mandible develops by a
rapid
spread
of
ossification backwards
into the mesenchyme of
the first branchial arch
diverging away from
Meckels cartilage. This
point of divergence is
marked
by
the
mandibular foramen.
The condylar cartilage:

Carrot shaped cartilage appears in the region of the condyle and
occupies most of the developing ramus. It is rapidly converted to
bone by endochondral ossification (14th. WIU) it gives rise to:
Condyle head and neck of the mandible.
The posterior half of the ramus to the level of inferior dental
foramen
The coronoid cartilage:

It is relatively transient growth cartilage
center ( 4th. - 6th. MIU). it gives rise to:
Coronoid process.
The anterior half of the ramus to the level of inferior
dental foramen
The alveolar process
It starts when the deciduous tooth

germs reach the early bell stage.
The bone of the mandible begins to
grow on each side of the tooth germ
By this growth the tooth germs come
to be in a trough or groove of bone,
which also includes the alveolar
nerves and blood vessels.
Later on, septa of bone between the

adjacent tooth germs develop, keeping
each tooth separate in its bony crept.
The mandibular canal is separated
from the bony crypts by a horizontal
plate of bone
The alveolar processes grow at a rapid
rate during the periods of tooth
eruption.
STRUCTURES ASSOCIATED WITH

MANDIBLE
BLOOD SUPPLY
MANDIBULAR
NERVE
Largest branch of trigeminal nerve

Mixed nerve with 2 roots
Large
Sensory
root
Small
motor
root
INNERVATION
Skin
Mucous
membrane
Mandibula
r teeth and
periodontal
ligament
Bone of
mandible
TMJ
Parotid
gland
S
E
N
S
O
R
Y
M
O
T
O
R
Masticatory
muscles,mass
eter,temporal
is,pterygoide
us medialis
and lateralis
mylohyoid
Ant. Belly
of digastric
Tensor
tympani
Tensor veli
palatine
BRANCHES
From undivided nerve
Anterior division
Posterior division
Branches from undivided

nerve
Nervous spinosus
Medial pterygoid nerve
Branches from anterior

division
MOTOR
Deep temporal
nerve
Masseteric
nerve
Lateral
pterygoid
SENSORY
Buccal nerve
or
buccinator nerve
or
long buccal nerve
Runs forward under lateral

pterygoid muscle
Lower head of
lat. pterygoid
Buccal nerve
Buccal nerve
Deep temporal
nerves
masseter
Lateral pterygoid
muscles
Emerges under anterior border of masseter

muscle.
Buccal nerve do not innervate buccinator
muscle,facial nerve does.
Branches from posterior

division
Lies medial to lateral pterygoid muscle
Gives off
1) auriculotemporal nerve
2) lingual nerve
3) Inferior alveolar nerve
Auriculotempora
l nerve
Lingual
nerve
Inferior
alveolar nerve
AURICULO TEMPORAL NERVE
o Traverses upper part of parotid gland

o Crosses posterior portion of zygomatic arch
o Gives off no: of branches
o Communicate with
facial nerve
otic ganglion
anterior auricular branches
branches to external acoustic meatus
branches to TMJ
superficial temporal branches.
LINGUAL NERVE
Run between tensor

veli palatine and
lateral pterygoid
Reaches lower
border
of lateral pterygoid
Run between
ramus and
medial
pterygoid
Run anterior and

medial to inferior
alveolar nerve
Reaches side of
tongue behind
III molar
INFERIOR ALVEOLAR
NERVE
Descends
medial to
lateral
pterygoid
muscle
Enters
mandibula
r canal
Inferior alveolar
nerve, artery, vein
travels through
mandibular canal
Exit of nerves, arteries and

veins at the mental foramen
as incisive nerve and mental
Mylohyoid nerve:
Branch from inferior alveolar nerve
runs downward and forward along
mylohyoid groove on medial suface of
ramus and reaches mylohyoid muscle
supplies skin on inferior and anterior
surface of mental protuberance
provide sensory innervation to
mandibular incisors and pulpal innervation
to mandibular molars.
once it enters the canal-travels anteriorly
with inferior alveolar artery and vein.
DENTAL PLEXUS
Serves mandibular posterior teeth
Provide pulpal innervation
Other fibers supply sensory innervation to
buccal periodontal tissues of same teeth
INCISIVE NERVE
Remain within the mandibular canal and
form nerve plexus that innervates pulpal
tissues of mandibular first premolar, canine,
incisors.
MENTAL NERVE
Exits through mental foramen
Divides into three branches
Innervates the skin of chin , skin and mucous
membrane of lower lip.
Techniques of
Mandibular
Anesthesia
Mandibular Nerve
Blocks
Inferior alveolar
Mental - Incisive
Buccal
Lingual
Gow-Gates
Vazirani Akinosi
Inferior Alveolar Nerve Block

Not a complete mandibular nerve block.
Requires supplemental buccal nerve block
May require infiltration of incisors or mesial
root of first molar
Inferior Alveolar Nerve Block

Nerves anesthetized
Inferior Alveolar
Mental
Incisive
Lingual
Areas Anesthetized
Mandibular teeth to midline
Body of mandible, inferior ramus
Buccal mucosa anterior to mental foramen
Anterior 2/3 tongue & floor of mouth
Lingual soft tissue and periosteum
Technique
Apply topical
Area of insertion:
- medial ramus, mid-coronoid notch,
- level with occlusal plane (1 cm above),
- 3/4 posterior from coronoid notch to
pterygomandibular raphe
- advance to bone (20-25 mm)
Target Area
Inferior alveolar nerve, near mandibular
foramen
Landmarks
Coronoid notch
Pterygomandibular raphe
Occlusal plane of mandibular posteriors
Precautions
Do not inject if bone not contacted
Avoid forceful bone contact
Complications
Hematoma
Trismus
Facial paralysis
Long Buccal Nerve Block
Anterior branch of Mandibular nerve (V3)

Provides buccal soft tissue anesthesia
adjacent to mandibular molars
Not required for most restorative procedures
Technique
Apply topical
Insertion distil and buccal to last molar
Target - Long Buccal nerve as it passes anterior
border of ramus
Insert approx. 2 mm, aspirate
Inject 0.3 ml of solution, slowly - 25-27 gauge needle
Area of insertion:
- Mucosa adjacent to most distal MOLAR
Landmarks
Mandibular molars
Mucobuccal fold
Mental Nerve Block

Terminal branch of IAN as it exits mental
foramen
Provides sensory innervation to buccal soft
tissue anterior to mental foramen, lip and
chin
Incisive Nerve Block

Terminal branch of IAN
Originates in mental foramen and proceeds
anteriorly
Good for bilateral anterior anesthesia
Not effective for anterior lingual anesthesia
Nerves anesthetized
Incisive
Mental
Areas Anesthetized
Mandibular labial mucous membranes
Lower lip / skin of chin
Incisor, cuspid and bicuspid teeth
Vazirani Akinosi
Gow Gates
THANK YOU

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Surgical Anatomy of Mandible: Department of Oral and Maxilofacial Surgery

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DEPARTMENT OF ORAL AND MAXILOFACIAL SURGERY

The mandible is ossified in the fibrous membrane covering

These cartilages form the cartilaginous bar of the

where the mandibular nerve

The lingual nerve passes

From the proximal end

Between the lingula and the canine

The mandible first

For each half of the mandible, Ossification takes

Ossification grows medially below the incisive

At the same stage the notch containing the

A similar spread of ossification in the

The ramus of the

The condylar cartilage:

The coronoid cartilage:

The alveolar process

It starts when the deciduous tooth

Later on, septa of bone between the

STRUCTURES ASSOCIATED WITH

Largest branch of trigeminal nerve

Branches from undivided

Branches from anterior

Runs forward under lateral

Emerges under anterior border of masseter

Branches from posterior

AURICULO TEMPORAL NERVE

o Traverses upper part of parotid gland

Run between tensor

Run anterior and

Exit of nerves, arteries and

Inferior Alveolar Nerve Block

Inferior Alveolar Nerve Block

Long Buccal Nerve Block

Anterior branch of Mandibular nerve (V3)

Mental Nerve Block

Incisive Nerve Block

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