This is not a new topic although I agree, most clinicians seem unaware of the possibility of such anatomic variants.

The real question is whether such anatomical distribution affects local anesthesia.

In a review of 2006, accessory innervation from the cervical plexus was listed as a possible cause of anesthesia failure (Boronat & Penarrocha 2006).

I have personally encountered a few cases of such suspected innervation that could be circumvented by local application of anesthesia in the first mandibular molar region.

Boronat A, Penarrocha M. Failure of locoregional anesthesia in dental practice : review of the literature. Med Oral Pathol Oral Cir Bucal 2006 ;11 :E10-3.

Nathan, thanks for your contribution. Dan.

hello:

this is a topic well known to dentist who work in the area of anesthesia and anatomy

since 1938 or even before  a paper was published  in CLINICAL VIGNETTE Transverse Cervical Nerve: Implications for Dental ... Adams, 1938;followed by  Jef- fries, 1944; followed by Nevin, 1948;followed by  Cook, 1951;and followed by  Sicher, 1946;

one of my students currently is mapping the mandibular Body and Ramus to see the existence of any foramina on the mandible other than the stranded mental foramen and the implication of these foramina for allowing  external   nerves and  blood vessels to enter the mandible  from the exterior side.

i have seen this phenomena of cervical nerves (the two nerves which are the  transverse cutaneous,and the greater auricular  nerve)     in many times entering the exterior surface of the mandible ,

cheers

prof K.galil

DDS.,D.Oral&Max Fac Surg.,Ph.D.,FAGD.,FADI.,Cert.Periodontist

Dear Professor K. Galil,

Thank you for your insight in this important area of research.

Please feel free to share with us your finding after its publication in order to add it to the accessory innervation body of knowledge in dental anesthesia.

All the best,

Dan.

Dear Dr Daniel Uzbelger Feldman ·

thank your for your interesting  answer .

 Your answer gave me some idea i might ask one of my student to study !!!!!

what we really need now is a Histological study to Discover  :

1- how far these two cervical nerves (greater auricular and transverse cervical nerves)  extend in the mandible once they perforate the exterior surface of the mandible.

2-do they supply the teeth or Just the mucosa or both

3- do they communicate  with the present nerve  whether it is the inferior alveolar nerve  or the mental nerve ,and i will go far and extend my neck and ask do they communicate with  the lingual nerve .Knowing very strongly that the lingual nerve is on the medial side of the mandible ,ie i am asking if these cutaneous nerve sit quite inside the mandible or even perforate the medial wall of the mandible and join the lingual nerve??

cheers

prof K..Galil

DDS.,D.Oral&Max Fac Surg.,Ph.D.,FAGD.,FADI.,Cert.Periodontist