Accessory nerve: effect on the patient’s sensory perception?
During routine ridge augmentation this accessory nerve was found approximately 6 mm above[superior to] the mental foramen. Does anyone know if compromising this nerve would likely have any noticeable effect on the patient’s sensory perception? The nerve was grafted over and the patient has not reported any change in sensory perception to date. Should the patient be tested for changes in perception over a particular timeline?
![]accessory-395K](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/12/accessory-395K-e1354865138518.jpg)
11 Comments on Accessory nerve: effect on the patient’s sensory perception?
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Leal
12/7/2012
Well that is a double mental foramen. It does exist. So no, do not damage it and I don't see any problems grafting on top of it. No problem at all. As long as the bone apposition won't struggle the nerve you won't have any sensory alterations.
Leal
12/7/2012
Oh boy. Strangle I mean not struggle. Sorry about that.
CRS
12/7/2012
If there was no immediate parethesia post op you should be okay. Interesting anatomy. Just document in the chart, nice post.
Richard Hughes, DDS, FAAI
12/7/2012
I suggest that you respect this structure. There is more literature appearing about accessory nerves. If the patient down not feel anything, OK. Sometimes the have a slight sensation after the procedure. Broad flaps and gentle soft tissue management go a long way.
CRS
12/8/2012
The literature while helpful is not as critical as identifying the anatomy at surgery and knowing how to manage it. I applaud the operator for accurate identification and management. The mental nerve is more forgiving than the main trunk, the important issue is understanding nerve paresthesias. My point is that at the first post op visit there is no sensory defect, document it. Stretching of the nerve during flap retraction or even exposure can cause a problem. Always have an OMS with experience to have your back if a paresthesias occurs. Early recognition will keep you out of trouble and court. Very good post.
Robert J. Miller
12/9/2012
Bifurcated or even trifurcated mental branches are more common than you think. Normally, the second branch is at the same level as the main trunk and it may be anterior or posterior. Occasionally, as you have encountered, there may be a superior branch. If you did not resect this neurovascular bundle, there is little chance for a sensory deficit. But this is why we suggest CBCT scans when performing surgery in this area. For some views of this type of anatomy, you can review our 2011 paper in Journal of Oral Implantology; "Maxillofacial Anatomy:The Mandibular Symphysis".
RJM
CRS
12/11/2012
Dr Miller could you give issue,volume and page number so I can have our hospital medical library get it for me? Very helpful thanks.
Baker k. Vinci
12/11/2012
You have manipulated the nerve and the patient had no subjective post op neurosensory changes. I would not worry about it. " it " is most likely similar to an incisive branch and of little consequence. Not to dissimilar from the psa, msa or asa nerves that we sacrifice on a daily basis. Bvinci
greg steiner
12/11/2012
The patient was just in for a two week post op visit and she reports no loss of sensory perception. Especially good as she is the wife of a referring dentist. I appreciate the oral surgeon’s comments as the rest of us do not have their background and training in this area. I look forward to reviewing Dr. Millers recommended article and if anyone has any suggestions on publications that deal with the subject of nerves, surgery and how to limit sensory loss it would be appreciated. Greg Steiner Steiner Laboratories
Robert J. Miller
12/11/2012
The paper is entitled "Maxillofacial Anatomy: The Mandibular Symphysis", published in the AAID's Journal of Oral Implantology, Vol. XXXVIII/No. Six/2011, pages 745-753. It is a CBCT study of the primary neurovascular vessels in the intraforaminal zone and variations of anatomy.
RJM
CRS
12/12/2012
Thank you Dr!
