Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Anatomy of the inferior alveolar nerve and its clinical implications
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a98
516-528
Anatomy of the inferior alveolar
nerve and its clinical implications
Anatomía del nervio dentario inferior y sus
implicaciones clínicas
Luis Eduardo Santaella Palma 1, Francisco Sánchez Almaraz 2, Edwin Orlando Romo Cepeda 3,
Stefan Salazar Villacres 4
1 Salesian Polytechnic University; lsantaella@ups.edu.ec. Guayaquil, Ecuador.
2 Salesian Polytechnic University; fsanchez@ups.edu.ec. Guayaquil, Ecuador.
3 Salesian Polytechnic University; eromo@ups.edu.ec. Guayaquil, Ecuador.
4 Salesian Polytechnic University; ssalazarv@ups.edu.ec. Guayaquil, Ecuador.
How to cite:
Santaella Palma, L. E., Sánchez Almaraz, F., Romo Cepeda, E. O., & Salazar Villacres, S. (2025). Anatomy of the
inferior alveolar nerve and its clinical implications. Multidisciplinary Journal of Contemporary Research,
3(2), 516-528. https://doi.org/10.58995/redlic.rmic.v3.n2.a98
Article Information
Received: 26-12-2024
Accepted: 26-03-2025
Published: 01-07-2025
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No conicts of interest are declared.
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Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 49 -49
Copyright (c) 2025 Faicán Rocano Pedro Fernando, Dután Pérez Ibelice Salomé,
González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a98
Revista multidisciplinaria
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Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 32 -49
Artículo Caso clínico. Revista multidisciplinaria investigación Contemporánea.
Vol. 3 - No. 2, pp. 32 - 49. julio-diciembre, 2025. e-ISSN: 2960-8015
Leucemia de células dendríticas
plasmocitoides - estudio y diagnóstico
de un caso
Leucemia de células dendríticas plasmocitoides - estudio y
diagnóstico de un caso
Información del artículo:
Recibido: 05-12-2024
Aceptado: 21-02-2025
Publicado: 01-07-2025
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1 Docente Investigador; pedro.faican@ucacue.edu.ec. Azogues, Ecuador.
2 Estudiante; ibelice.dutan.44@est.ucacue.edu.ec. Azogues, Ecuador.
3 Estudiante; camila.gonzalez.66@est.ucacue.edu.ec. Azogues, Ecuador.
4 Estudiante; joselyn.matute.44@est.ucacue.edu.ec. Azogues, Ecuador.
5 Estudiante; alejandra.rodriguez.60@est.ucacue.edu.ec. Azogues, Ecuador.
Faicán Rocano Pedro Fernando 1, Dután Pérez Ibelice Salomé 2, González González Camila
Raquel 3, Matute Aguiar Joselyn Nayeli 4, Rodríguez Verdugo Alejandra Valentina 5
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Cómo citar:
Faican Rocano, P. . F., Dután Pérez, I. S. ., González González, C. R. ., Rodríguez Verdugo, A. V. ., & Matute Aguiar, J.
N. . (2025). Leucemia de células dendríticas plasmocitoides - estudio y diagnóstico de un caso.
Revista Multidisci-
plinaria Investigación Contemporánea
, 3(2), 32-49. https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Revista multidisciplinaria
investigación Contemporánea ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025
Anatomy of the inferior alveolar nerve and its clinical implications
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a98
517-528
Summary
Introduction: The inferior alveolar nerve is one of the terminal branches
that gives off the third branch of the trigeminal nerve. Injury to the inferior alveolar
nerve has a prevalence ranging from 0.53 to 8.4%. Objective: To analyze the most
relevant aspects concerning the anatomy of the inferior alveolar nerve and its main
clinical implications . Methodology : A narrative review was conducted, in which 19
publications were selected from the following databases: SCOPUS, PubMed, Web of
Science , Google Scholar and human anatomy textbooks, during July to December
2024. Results: The inferior alveolar nerve can be injured in dental procedures such
as the placement of dental implants, third molar extractions, lower posterior teeth,
retained teeth, endodontic treatments, periradicular surgeries , orthognathic
surgeries, distraction osteogenesis and mandibular trauma. Conclusions: It
is essential to know the typical anatomy of the inferior alveolar nerve and its
anatomical variants, to reduce the risk of injury.
Keywords: Dentistry, anatomy, inferior dental nerve.
Resumen
Introducción: El nervio dentario inferior es una de las ramas terminales que
emite la tercera rama del nervio trigémino. La lesión del nervio dentario inferior
tiene una prevalencia que oscila entre el 0,53 y el 8,4%. Objetivo: Analizar los
aspectos más relevantes concernientes a la anatomía del nervio dentario inferior
y sus principales implicaciones clínicas. Metodología: Se efectuó una revisión
narrativa, en la que se seleccionaron 19 publicaciones en bases de datos: SCOPUS,
PubMed, Web of Science, Google académico y libros de texto de anatomía humana,
durante julio a diciembre de 2024. Resultados: El nervio dentario inferior puede
lesionarse en procedimientos odontológicos como la colocación de implantes
dentales, extracciones de terceros molares, piezas dentarias el sector postero
inferior, dientes retenidos, tratamientos endodónticos, cirugías perirradiculares,
ortognáticas, distracciones osteogénicas y trauma mandibular. Conclusiones: Es
fundamental conocer la anatomía típica del nervio dentario inferior y sus variantes
anatómicas, para disminuir el riesgo de lesiones.
Palabras clave: Odontología, anatomía, nervio dentario inferior.
Revista multidisciplinaria
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Anatomy of the inferior alveolar nerve and its clinical implications
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1. Introduction
The inferior alveolar nerve, together with the lingual nerve, are the
terminal branches of the posterior trunk of the mandibular nerve, which
constitutes the third branch of the fth cranial nerve (trigeminal nerve).
The inferior alveolar nerve is purely sensory, providing sensitivity through
its branches to all lower teeth, adjacent bone tissue, the vestibular gingiva,
and soft tissues of the mental area (1,2,3).
Injury to the inferior alveolar nerve has a prevalence ranging
from 0.53 to 8.4% (4). Considering the importance of understanding the
course and branches of this nerve in preventing injury in various dental
and maxillofacial procedures, it is therefore pertinent to conduct this
literature review to analyze the most relevant aspects of the anatomy of
the inferior alveolar nerve and its main clinical implications.
2. Methodology
A narrative description was made regarding the anatomical
considerations of the internal dental nerve and its clinical implications.
The search strategy took into account criteria such as: relevance and
origin of the data, objective development of the content, and scope of
the research. Based on these parameters, 19 publications were selected,
including: review articles, original articles, textbooks, and clinical cases
related to the subject of study, in English and Spanish. The information
was collected from databases, platforms, and/or virtual libraries such as
SCOPUS, PubMed, Web of Science, Google Scholar, as well as the human
anatomy book, between July 2024 and December 2024.
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3. Development
3.1. Common anatomical presentation of the inferior alveolar nerve
The inferior alveolar nerve begins about 5 millimeters inferior to
the foramen ovale in the zygomatic fossa and descends anterior to the
dental artery, relating medially to the internal pterygoid muscle and the
interpterygoid aponeurosis . It is also related laterally to the ascending
branch of the mandible and the external pterygoid muscle as far as the
mandibular foramen (2,5,6).
It gives off the mylohyoid nerve before entering the inferior dental
canal or mandibular canal. It runs in the inferior dental canal, gives off
an internal branch, known as the incisive branch, and an external branch,
which emerges through the mental foramen, called the mental nerve ( 5,6).
In histological studies of the inferior dental nerve, a single trunk has
frequently been described that divides at the level of the molars into two
extensive nerves that extend in a spiral: the incisive nerve and the mental
nerve (7).
The mental nerve supplies branches to the skin and mucosa of the
lower lip, as well as the skin of the chin. The incisive nerve, meanwhile,
continues anteriorly through the mandibular canal and gives off branches
to the incisors, canine, and adjacent gingiva (2,5-7).
Most radiological and cadaveric ndings have reported that the
inferior alveolar nerve has a plexiform conguration, receiving bony
perforating branches from neurovascular bundles that emit adjacent
muscular structures. These accessory alveolar nerves are especially
visible in a lateral plane of each mandibular third molar and constitute a
relatively frequent cause of incomplete inhibition of local pain after the
application of anesthesia for inferior alveolar nerve block (2,6,8).
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3.2. Anatomy of the mandibular canal
The mandibular canal, also known as the inferior dental canal or
inferior alveolar canal, begins with the mandibular foramen, located
on the inner surface of the mandible. The mandibular canal is located
anterior to a bony eminence called the lingula. The mandibular canal
passes through part of the body of the mandible and ends at each mental
foramen (6,9). (See Figure 1)
Figure 1. Mandibular canal. The sagittal section shows the course
of the mandibular canal, from the mandibular foramen to the mental
foramen, between which the inferior alveolar nerve runs. Source: Image
obtained at the dental clinic of the Salesian Polytechnic University
(Guayaquil campus).
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3.3. Anatomical variations of the inferior alveolar nerve
The injuries of the alveolar nerve can be of great magnitude according
to the scale of the pain to such an extent that they can compromise the
quality of life of the patient in such a way that the adequate identication
and perception of the anatomy of the inferior dental nerve is essential for
any oral surgery intervention in the mandibular region. Therefore, it is
important to know the variations in terms of morphology, course and its
various relationships with the adjacent structures and the behavior of
the nerve in its intraosseous mandibular course in order to make a good
diagnosis, as well as to avoid injuries to the nerve in any dental procedure
(1-4).
The inferior dental nerve mainly runs, in cadaveric dissections,
with three presentations of anatomical variants: a) constituted by a single
trunk that is distributed throughout all the apices of the lower teeth; b)
fragmented into small branches; c) this type is initially divided into two
branches, an upper one responsible for innervating the second and third
molars, and a branch located apically that provides innervation to the
remaining lower teeth (10,11).
Nortj e & Farman (12) described four anatomical variants in relation
to the mandibular canal, according to the ndings detected in panoramic
radiographs: a) a single bilateral and simple canal; b) a single bilateral
canal, but with a radiologically intermittent path; c) several small-caliber
canals; d) mandibular canal not visible or with a double shape .
Among the most common variations we can nd the double or
bid inferior alveolar nerve, described in the study carried out by the
aforementioned authors, who indicate that up to 0.9% of individuals had
a bid nerve displayed in the x-rays taken, of which 20% were bilateral
and 13% were unilateral. Therefore, within the contextual study of the
mandibular area, these variations in the anatomy that can be detected
from the radiological level are considered together and that may be
subject to variations in age, taking into account that, the older the patient,
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the mandibular canal through which the inferior alveolar nerve runs is
usually located in a higher position (12).
3.4. Clinical implications of the inferior alveolar nerve.
In dental practice there are numerous procedures performed
on the jaw, to mention a few examples: placement of dental implants,
extractions of third molars, teeth in the lower posterior sector, retained
teeth, endodontic treatments, peri-radicular surgeries, orthognathic
surgeries, osteogenic distractions, mandibular trauma, among others, and
despite the fact that the anatomy of the inferior alveolar nerve is known,
iatrogenic injuries of the inferior alveolar nerve are well documented (13).
Among the most frequent injuries of the inferior alveolar nerve due
to lack of knowledge of its anatomy are: lacerations, neurosensory injuries
such as neurapraxia, axonotmesis and neurotmesis that can occur due to
compression or stretching. In the rst, the nerve is anatomically intact,
but is unable to conduct the nerve impulse. This can be caused by any
type of external pressure (14) .
The Axonotmesis is a more severe injury because it involves axonal
degeneration. The main clinical implication is that it requires a longer
recovery period compared to neurapraxia. On the other hand, axonal
degeneration requires a longer recovery period. In neurotmesis, there
is a complete disruption of the axon and the myelin sheath. Complete
deterioration of nerve function is evident, in which case surgical
intervention is indicated (14).
Neurosensory lesions can cause chronic pain and complete
anesthesia of the areas innervated by the affected nerve. Chemical
damage may also occur from components used in endodontic treatments
such as formaldehyde, corticosteroids, eugenol, and sodium hypochlorite.
Thermal damage may occur due to bone overheating during procedures
(15).
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The technique for procedures on third molars that are anatomically
related to the inferior alveolar nerve consists of anesthesia, incision,
osteotomy, odontosection, and extraction. An intentional coronectomy
has been proposed to allow mesial migration of the tooth and avoid injury
to the inferior alveolar nerve (4).
3.5. Damage to the inferior alveolar nerve
Damage to the inferior alveolar nerve is a signicant complication
in dentistry and oral surgery. The inferior alveolar nerve is responsible
for sensation in the jaw, lower teeth, and lip, so injury to it can result in
partial or complete loss of sensation in these areas, as well as neuropathic
pain. The most common causes of damage to the inferior alveolar nerve
include the extraction of third molars (wisdom teeth), dental implants,
orthognathic surgery, endodontic procedures, lateralization of the nerve,
and mandibular fractures. Inammatory diseases, such as osteomyelitis,
can also affect this nerve (16).
Symptoms of inferior alveolar nerve damage vary depending on
the severity of the injury and include paresthesia (tingling), anesthesia
(complete loss of sensation), and neuropathic pain (pain caused by the
nerve injury). Diagnosis of inferior alveolar nerve damage is made by a
combination of clinical evaluation and imaging tests, such as X-rays and
computed tomography (CT). Sensory testing is also useful in assessing the
degree of nerve injury (17).
Treatment for damage to the inferior alveolar nerve depends on the
severity of the injury. Options include: a) Conservative treatment: Pain
medication, anti-inammatory drugs, and regular follow-up to observe
the nerve’s natural recovery; b) Surgical interventions: In severe cases,
procedures such as nerve decompression and microsurgery may be
considered to repair the nerve; c) Physical therapies: Electrical stimulation
and low-level laser therapy can aid in nerve regeneration and functional
recovery; d) Prognosis: The prognosis for recovery from damage to the
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inferior alveolar nerve varies widely. Factors such as the patient’s age,
the extent of the damage, and the promptness of treatment inuence the
results. Most patients experience some improvement over time, although
some may have permanent after-effects (18).
Proper management of inferior alveolar nerve damage is crucial
to minimize complications and improve the patient’s quality of life.
A combination of accurate diagnosis and individualized treatment is
essential to optimize nerve recovery outcomes.
3.6. Recovery of the inferior alveolar nerve
The recovery of the inferior alveolar nerve is a topic of great
relevance in dentistry due to its involvement in the sensory function of
the mandible. Injuries to the inferior alveolar nerve can occur for various
reasons, including dental surgical procedures, mandibular fractures
and inammatory diseases. Some therapies have been proposed for the
recovery of the nerve, being some minimally invasive alternatives, such as
pharmacotherapy and other more invasive ones such as decompression
surgical interventions, each of these having its success rate (19).
Pharmacological therapies, including anti-inammatory and
neuroprotective agents, have been shown to be useful in reducing
inammation and promoting nerve regeneration. Surgical interventions,
such as nerve decompression and microsurgical repair, are used in cases of
severe injuries with varying results. On the other hand, physical therapies,
including electrical stimulation and low-level laser therapy, have shown
promising results in accelerating nerve recovery. Nerve recovery time can
vary, ranging from 6 months to 1 year, or even in cases where the damage is
already permanent. To verify the recovery of nerve sensitivity, a mapping
of the affected area is chosen (19).
It is concluded that recovery from damage to the inferior alveolar
nerve is a complex process dependent on multiple factors, and that a
combination of different therapeutic approaches can offer the best results.
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An individualized evaluation of each case is recommended to determine
the most appropriate treatment.
5. Conclusions
The alveolar nerve is an anatomical structure of special importance
in various dental procedures, such as the placement of dental implants,
third molar extractions, mandibular posterior teeth, impacted teeth,
endodontic treatments, peri-radicular surgery, orthognathic surgery, as
well as distraction osteogenesis and mandibular trauma. Therefore, it is
essential to understand the typical anatomy of the inferior alveolar nerve
and its main anatomical variants.
5. Contribution of the authors
LESP: Bibliographic search, introduction, methodology, development,
conclusions.
FSA: Bibliographic search, development and conclusions.
EORC: Bibliographic search and development.
SSV: Bibliographic search and development.
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Copyright (c) 2025 Luis Eduardo Santaella Palma, Francisco Sánchez
Almaraz, Edwin Orlando Romo Cepeda, Stefan Salazar Villacres.
This text is protected by a Creative Commons 4.0 license.
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Revista multidisciplinaria
Investigación Contemporánea 07 - 2025 Vol. 3 - No. 2 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90
Leucemia de células dendríticas plasmocitoides
- estudio y diagnóstico de un caso 49 -49
Copyright (c) 2025 Faicán Rocano Pedro Fernando, Dután Pérez Ibelice Salomé,
González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-
dugo Alejandra Valentina.
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