How to differentiate between pterygomandibular space and submasseteric space infection?
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Inferior Alveolar Nerve Repair
The IAN has a long course; it branches from the mandibular nerve in the pterygomandibular space, travels anteriorly until it enters the mandibular foramen on the medial mandible, continues within the inferior alveolar canal, and just before exiting at the mental foramen, divides into its two terminal branches, the incisive nerve and the mental nerve. Injuries to the nerve at the mandibular canal and more proximally in the pterygomandibular space are difficult to visualize and repair without performing a mandibular ramus osteotomy for additional access. Such operations are seldom done for nerve repair unless performed as part of tumor resection. The IAN at the area of the third molar can be accessed with both intraoral and transcutaneous incisions. The standard Risdon incision allows excellent access to the entire nerve from the area of the mandibular canal to the mental foramen. The main disadvantages of this access are scarring (especially in younger individuals who do not have a naturally visible neck crease) and a small possibility of injury to the marginal mandibular nerve (about 1% in our experience). Figure 29-9shows photos of young patients with esthetically pleasing neck scars after IAN repair and harvesting of a GAN graft. The nerve can also be accessed intraorally via a variety of techniques, including a modified SSRO or removal of the external oblique ridge and superior lateral cortex
The IAN has a long course; it branches from the mandibular nerve in the pterygomandibular space, travels anteriorly until it enters the mandibular foramen on the medial mandible, continues within the inferior alveolar canal, and just before exiting at the mental foramen, divides into its two terminal branches, the incisive nerve and the mental nerve. Injuries to the nerve at the mandibular canal and more proximally in the pterygomandibular space are difficult to visualize and repair without performing a mandibular ramus osteotomy for additional access. Such operations are seldom done for nerve repair unless performed as part of tumor resection. The IAN at the area of the third molar can be accessed with both intraoral and transcutaneous incisions. The standard Risdon incision allows excellent access to the entire nerve from the area of the mandibular canal to the mental foramen. The main disadvantages of this access are scarring (especially in younger individuals who do not have a naturally visible neck crease) and a small possibility of injury to the marginal mandibular nerve (about 1% in our experience). Figure 29-9shows photos of young patients with esthetically pleasing neck scars after IAN repair and harvesting of a GAN graft. The nerve can also be accessed intraorally via a variety of techniques, including a modified SSRO or removal of the external oblique ridge and superior lateral cortex
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