• Journal of Korean Neurosurgical Society
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• v.51 no.1
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• pp.44-46
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• 2012

The sternocleidomastoid (SCM) artery supplying blood to the SCM muscle has different origins according to its anatomical segment. The authors performed cadaveric neck dissection to review the surgical anatomy of neurovascular structures surrounding the carotid artery in the neck. During the dissection, an unusual finding was cited in which the SCM artery supplying the middle part of the SCM muscle originated from the lingual artery (LA); it was also noted that it crossed over the hypoglossal nerve (HN). There have been extremely rare reports citing the SCM artery originated from the LA. Though the elevation of the HN over the internal carotid artery was relatively high, the vascular loop crossing over the HN was very close to the carotid bifurcation. Special anatomical consideration is required to avoid the injury of the HN during carotid artery surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.1
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• pp.61-65
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• 2022

Trigeminocardiac reflex (TCR) is a well-known brainstem reflex that manifests as hypotension, bradycardia, dysrhythmia, and asystole when stimulation is applied to a branch of the trigeminal nerve. Most commonly associated with ophthalmic, orbital, and neurologic surgeries, mandibular division and oral cavity variants occur far less frequently. Here, we describe a case of asystolic TCR elicited by lingual nerve stimulation. This case highlights the role of specific anesthetic medications in modulating this phenomenon and reinforces the need for early recognition and clear communication in case of its occurrence. Anesthesia providers must consider discontinuing or avoiding certain medications when clinically appropriate, even during low TCR-risk procedures.

• Korean Journal of Veterinary Research
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• v.38 no.3
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• pp.474-487
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• 1998

The present study was undertaken to investigate the morphological characteristics of trigeminal nerve in the Korean native goat by macroscopic methods. Trigeminal nerve was originated from the lateral side of pons, and extended shortly forward to form trigeminal ganglion at the opening of oval foramen. Thereafter this nerve was divided into maxillary, mandibular and ophthalmic nerve. Ophthalmic nerve gave off the zygomaticotemporal branch, frontal nerve, frontal sinus branch, and was continued as the nasociliary nerve. Maxillary nerve gave rise to the zygomaticofacial branch, accessory zygomaticofacial branch, communicating branch with oculomotor nerve, pterygopalatine nerve, caudal superior alveolar branch, malar branch and was continued as the infraorbital nerve. Mandibular nerve was divided into the masseteric nerve, buccal nerve, lateral pterygoid nerve, medial pterygoid nerve, nerve to tensor tympani m., auriculotemporal nerve, and furnished the inferior alveolar nerve and lingual nerve as terminal branches. The course and distribution of the trigeminal nerve in the Korean native goat appeared to be similar to that in other small ruminants such as sheep and goat. But the main differences from other small ruminants were as follows : 1. There was no accessory branch of the major palatine nerve. 2. The caudal superior alveolar branch was directly branched from the maxillary nerve. 3. The communicating branch with oculomotor nerve was originated from maxillary nerve or common trunk with zygomaticofacial branch. 4. The malar branch arose from the maxillary nerve at the rostral to the origin of the caudal superior alveolar branch. 5. The inferior alveolar nerve originated in a common trunk with the lingual nerve. 6. The mylohyoid nerve arose at the origin of the inferior alveolar nerve. 7. The zygomaticotemporal branch was single fascicle, and gave off lacrimal nerve and cornual branch. 8. The base of horn was provided by the cornual branches of zygomaticotemporal branch and infratrochlear nerve of nasociliary nerve.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.40 no.6
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• pp.278-284
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• 2014

Objectives: This study used cone-beam computed tomography (CBCT) images to categorize the relationships between the mandibular canal and the roots and investigated the prevalence of nerve damage. Materials and Methods: Through CBCT images, contact and three-dimensional positional relationships between the roots of the mandibular third molar and the mandibular canal were investigated. With this data, prevalence of nerve damage according to the presence of contact and three-dimensional positional relationships was studied. Other factors that affected the prevalence of nerve damage were also investigated. Results: When the mandibular third molar and the mandibular canal were shown to have direct contact in CBCT images, the prevalence of nerve damage was higher than in other cases. Also, in cases where the mandibular canal was horizontally lingual to the mandibular third molar and the mandibular canal was vertically at the cervical level of the mandibular third molar, the prevalence of nerve damage was higher than in opposite cases. The percentage of mandibular canal contact with the roots of the mandibular third molar was higher when the mandibular canal was horizontally lingual to the mandibular third molar. Finally, the prevalence of nerve damage was higher when the diameter of the mandibular canal lumen suddenly decreased at the contact area between the mandibular canal and the roots, as shown in CBCT images. Conclusion: The three-dimensional relationship of the mandibular third molar and the mandibular canal can help predict nerve damage and can guide patient expectations of the possibility and extent of nerve damage.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.1
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• pp.5-9
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• 2003

Introduction : Laryngomicrosurgery(LMS) is frequent procedure applying to benign and early malignant larygeal disease such as vocal cord polyp, nodule and early glottic cancer. LMS has been known as safe procedure and short time consuming treatment. So few reports about complications in LMS was done. In this study, complications and problems from LMS were investigated and reported. Method : From 2000, January to 2001, December, 180 patients who were treated with LMS in Asan medical center were studied by retrograde chart review. Results : In these patients, total 9 patients(5%) were suffered from complication. 4 patients (2%) had teeth injury and 4(2%) were suffered from foreign body sensation in tongue and 1(1%) had hypoglossal nerve injury. Main mechanism of complications is thought by pressure injury by laryngoscope blade. No definite correlation between procedure and complication was observed. Conclusion : There are few neural complications with LMS such as lingual and hypoglossal nerve injury. Before operation of LMS, warning and informing of complications by mechanical stress must be done. Gentle procedure and short operation time are necessary to avoid these problems. And patients who have risk factors of oral complications such as dental disease or dental prosthesis must have dental evaluation and treatment before LMS procedure.

• Imaging Science in Dentistry
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• v.37 no.4
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• pp.217-220
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• 2007

Purpose: The purpose of this study was to compare the location of the mandibular canal in Class III malocclusion to its location in normal occlusion for adults. Materials and Methods: For this study 32 skeletal Class III patients and 26 normal patients were observed. Four measurements were taken on cross sectional tomography between the first and second molars: the distance from the mandibular canal to the inner surface of both the buccal and lingual cortices, the distance from the mandibular canal to the inferior border of the mandible, and the buccolingual width of the mandible. The buccolingual location of the canals was classified as lingual, central, or buccal. Each measurement was analyzed with an independent t test to compare Class III malocclusion to normal occlusion. Results: Compared to the control group, the prognathic group had a shorter distance from the canal to the inner surface of the lingual cortex and to the base of the mandible. A higher percentage of the canals were located lingually in the prognathic group. Conclusion: This study showed that the mandibular canal was located more lingually and inferiorly in prognathic patients than in patients with normal occlusion. These results could help surgeons to reduce injuries to the inferior alveolar nerve.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.4
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• pp.315-321
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• 2022

Although rare, hypodermic needle fractures can occur in the maxillofacial region. In cases of fracture, urgent intervention is required to prevent further complications. We present the case of a 37-year-old female patient with a fractured needle in the left sublingual fossa during a lingual nerve block 6 months before referral. The fragment of a 30-gauge needle was located using cone-beam computed tomography and retrieved under local anesthesia with blunt dissection. The patient recovered uneventfully, except for predictable postoperative inflammatory complications, which resolved within 2 weeks. Precautions should be implemented to prevent needle fractures, which are usually preventable. However, if the retrieval is unsuccessful, the patient should be referred to a well-equipped surgical unit without delay.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.66-73
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• 2015

Objectives: To assess the validity of the vertical tube-shift method using intraoral periapical radiography (IOPAR) for determining the relationship between the mandibular third molar roots and the inferior alveolar nerve (IAN) canal in comparison with cone-beam computed tomography (CBCT). Materials and Methods: Fifty impacted mandibular third molars were analyzed using the IOPAR vertical tube-shift method and CBCT. The relationship of the IAN canal to the impacted mandibular third molar was recorded as buccal, lingual or in line with the apex and was compared with CBCT findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the vertical tube-shift method in depicting the relationship (buccal/lingual/in line with the apex) of the IAN canal to the third molar root apex was calculated. Results: The sensitivity and specificity PPV and NPV of the IOPAR vertical tube-shift technique was found to be highest for a lingual relationship (100%) followed by buccal (94.4%, 92.3%, 97.1%, and 85.7%) and in line with the apex relationship (88.9%, 95.0%, 80.0%, and 97.4%) of the IAN canal with the third molar root apex, respectively. A statistically significant association was observed between the IOPAR vertical tube-shift method and the CBCT with a P-value <0.01. Conclusion: The vertical tube-shift method can be used as an effective diagnostic tool in assessing the relationship of the IAN canal to the third molar root apex with high sensitivity, specificity, PPV, and NPV.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.5
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• pp.375-395
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• 2006

Purpose: Lingual nerve (LN) damage may be caused by either tumor resection or injury such as wisdom tooth extraction, Although autologous nerve graft is sometimes used to repair the damaged nerve, it has the disadvantage of necessity of another operation for nerve harvesting. Moreover, the results of nerve grafting is not satisfactory. The nerve growth factor (NGF) is well-known to play a critical role in peripheral nerve regeneration and its local delivery to the injured nerve has been continuously tried to enhance nerve regeneration. However, its application has limitations like repeated administration due to short half life of 30 minutes and an in vivo delivery model must allow for direct and local delivery. The aim of this study was to construct a well-functioning $rhNGF-{\beta}$ adenovirus for the ultimate development of improved method to promote peripheral nerve regeneration with enhanced and extended secretion of hNGF from the injured nerve by injecting $rhNGF-{\beta}$ gene directly into crush-injured LN in rat model. Materials and Methods: $hNGF-{\beta}$ gene was prepared from fetal brain cDNA library and cloned into E1/E3 deleted adenoviral vector which contains green fluorescence protein (GFP) gene as a reporter. After large scale production and purification of $rhNGF-{\beta}$ adenovirus, transfection efficiency and its expression at various cells (primary cultured Schwann cells, HEK293 cells, Schwann cell lines, NIH3T3 and CRH cells) were evaluated by fluorescent microscopy, RT-PCR, ELISA, immunocytochemistry. Furthermore, the function of rhNGF-beta, which was secreted from various cells infected with $rhNGF-{\beta}$ adenovirus, was evaluated using neuritogenesis of PC-12 cells. For in vivo evaluation of efficacy of $rhNGF-{\beta}$ adenovirus, the LNs of 8-week old rats were exposed and crush-injured with a small hemostat for 10 seconds. After the injury, $rhNGF-{\beta}$ adenovirus($2{\mu}l,\;1.5{\times}10^{11}pfu$) or saline was administered into the crushed site in the experimental (n=24) and the control group (n=24), respectively. Sham operation of another group of rats (n=9) was performed without administration of either saline or adenovirus. The taste recovery and the change of fungiform papilla were studied at 1, 2, 3 and 4 weeks. Each of the 6 animals was tested with different solutions (0.1M NaCl, 0.1M sucrose, 0.01M QHCl, or 0.01M HCl) by two-bottle test paradigm and the number of papilla was counted using SEM picture of tongue dorsum. LN was explored at the same interval as taste study and evaluated electro-physiologically (peak voltage and nerve conduction velocity) and histomorphometrically (axon count, myelin thickness). Results: The recombinant adenovirus vector carrying $rhNGF-{\beta}$ was constructed and confirmed by restriction endonuclease analysis and DNA sequence analysis. GFP expression was observed in 90% of $rhNGF-{\beta}$ adenovirus infected cells compared with uninfected cells. Total mRNA isolated from $rhNGF-{\beta}$ adenovirus infected cells showed strong RT-PCR band, however uninfected or LacZ recombinant adenovirus infected cells did not. NGF quantification by ELISA showed a maximal release of $18865.4{\pm}310.9pg/ml$ NGF at the 4th day and stably continued till 14 days by $rhNGF-{\beta}$ adenovirus infected Schwann cells. PC-12 cells exposed to media with $rhNGF-{\beta}$ adenovirus infected Schwann cell revealed at the same level of neurite-extension as the commercial NGF did. $rhNGF-{\beta}$ adenovirus injected experimental groups in comparison to the control group exhibited different taste preference ratio. Salty, sweet and sour taste preference ratio were significantly different after 2 weeks from the beginning of the experiment, which were similar to the sham group, but not to the control group.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.5
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• pp.325-329
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• 2020

Classic anesthetic techniques for the inferior alveolar nerve, lingual nerve, and long buccal nerve blockade are achieved by estimating the intended location for anesthetic deposition based on palpation, inspection, and subsequent correlation for oral anatomical structures. The present article utilizes computed tomography (CT) data to 3D print a guide for repeatable and accurate deposition of a local anesthetic at the ideal location. This technical report aims to anatomically define the ideal location for local anesthetic deposition. This process has the potential to reduce patient discomfort, risk of nerve damage, and failed mandibular anesthesia, as well as to reduce the total anesthetic dose. Lastly, as robotic-based interventions improve, this provides the initial framework for robot-guided regional anesthesia administration in the oral cavity.