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Mandibular V3 (Posterior Trunk Formed by merging of Auriculotemporal,…

- - - - Jugular Foramen Tympanic branch of IX CN
      - Tympanic plexus
      - Relay in Otic Ganglion
      - Post- ganglionic PNS fibres join Auriculotemporal nerve
      - Parotid Gland
      - Lesser petrol branch of V3
  - - - Runs at base of tongue between medial pterygoid muscle & mandible with the IA nerve anterior & inferior (IA nerve block often anaesthetises lingual nerve)
      - Afferent supply to floor of mouth, general sensation of the tongue, lingual gingival of mandibular teeth
      - Anterior 2/3: V CN - Trigeminal ganglion - V3 - lingual nerve- tongue general sensation
      - Lingual nerve also communicates with Submandibular Ganglion - PSN innervation to submandibular & sublingual salivary glands
        
        Submandibular & Sublingual Salivary Gland Innervation
        
        -Chorda Tympani branch of VII
        
        Joins lingual nerve
        
        Submandibular Ganglion
        
        Relay Post Ganglionic fibres
        
        Submandibular & Sublingual Salivary Glands
        
        VII CN
  - - - Incisive Nerve
        
        Afferent supply to Mandibular premolars & anterior teeth
        
        Emerges via the mental foramen merging with mental nerve
      - Mylohyoid nerve
        
        After the IA nerve exits mandibular foramen- mylohyoid branch occurs
        
        Mylohyoid nerve & vessels runs across the mylohyoid groove
        
        Efferent (motor) supply to Mylohyoid muscle & anterior belly of digastric muscle
      - Mental nerve V3
        
        Mental nerve Block!! (2/3 of Cartridge)
        
        Site: Pull down lower lip- expose muccobuccal fold 2) inject anterior to mental foramen where mental nerve joins incisive nerve 3) Rx can be used to locate mental foramen if difficulties
        
        Numbs: Incisors, Canine, 1st & 2nd Premolars, lower lip & chin
        
        Landmark: Mandibular premolars & muccobuccal fold with mental foramen
    - - IA Nerve Block!! (1 cartridge)
        
        Site: 1) Needle approaches from opposite side from between pre-molars- 1cm above the occlusal plane & parallel 2) place needle lateral to PMR - medial & mid-level to thumb. 3) Advance needle approx 2.5cm slowly- lightly touching bone (1cm of needle outside of tissue) 4) Withdrawal & aspirate- if negative inject whilst aspirating periodically. if positive / hit bone too soon- withdraw slightly and reduce angulatation (bring syringe between canine & incisor region) if hit no bone do again but angulate needle between premolar & molar!
        
        Numbs: teeth in quadrant, soft buccal tissue from mental nerve to midline, tongue & lingual soft tissue
        
        Landmark: 1) Ask pt to open mouth wide . 2) Palpate with thumb to locate - Anterior border of Ramus, External Oblique Ridge, Coronoid
        Notch & Internal Oblique Ridge. 3) Pull soft tissue taught & slide thumb laterally on External Oblique Ridge 4) Pterygomandibular Raphe should now be visible
- - - - Landmark: Locate the most distal molar tooth & muccobuccal fold
      - Site: Distal & buccal of most distal molar in the arch of anterior boarder of rams
      - Numbs Soft tissues & Periostium buccal to mandibular molars
  - - - Travels in deep surface of the Lateral Pterygoid muscle between the 2 heads
        
        Efferent supply to Lateral Pterygoid muscle
    - - Along with Masseteric blood vessels via mandibular notch
        
        Supplies Efferent innervation to Masseter Muscle
    - - Efferent (motor) innervation to Temporalis muscle