Anatomical Variation of the Auriculotemporal Nerve in Thai Cadavers / Variación Anatómica del Nervio Auriculotemporal en Cadáveres Tailandeses

SUMMARY: The auriculotemporal nerve (ATN) is an important structure lying within a limited area of an infratemporal region (ITR). The ATN is originated from the posterior branch of the mandibular division of the trigeminal nerve (V3). The ATN conveys somatosensory, secretomotor, and parasympathetic fibres of the V3 and gustatory nerve (CN IX). In literature, the most common pattern of the ATN is composed of 2 roots that encloses the middle meningeal artery (MMA). However, in many studies, it has been reported that there are many variations in ATN pattern formation. To study the variation of ATN pattern formation in Thai cadavers, 73 hemifaces from 39 Thai embalmed cadavers were dissected and the relations of the ATN to the MMA were recorded. This study concluded that there were 4 patterns observed in Thai cadavers. The common pattern is 2 roots (67.1 %), 3 roots (15.1 %), 1 root (9.6 %), and 4 roots (8.2 %). Knowledge of this variation in the ATN may be useful in understanding the symptoms of temporo-orofacial pain, paresthesia of temporomandibular joint (TMJ), possible side effects from the TMJ surgery and the efficiency of auriculotemporal nerve block for regional anesthesia of the temporomandibular joint in Thai people.

RESUMEN: El nervio auriculotemporal (NAT) es una estructura importante que se encuentra dentro de la región infratemporal (ITR). El NAT se origina en la rama posterior de la división mandibular del nervio trigémino (V3), y transmite fibras somato sensoriales, secreto motoras y parasimpáticas del V3 y del nervio gustativo (CN IX). En la literatura, se reporta que el patrón más común de NAT está compuesto por 2 raíces que contienen la arteria meníngea media (AMM). Sin embargo, en diversos estudios, se ha informado que existen múltiples variaciones en la for- mación de patrones NAT. Con el objetivo de estudiar la variación de la formación del patrón NAT en cadáveres tailandeses, se disecaron 73 estructuras hemi faciales de 39 cadáveres tailandeses y se registraron las relaciones del NAT con el AMM. En conclusión, se observaron 4 patrones en los cadáveres tailandeses. El patrón común de 2 raíces (67,1 %), 3 raíces (15,1 %), 1 raíz (9,6 %) y 4 raíces (8,2 %). El conocimiento de esta variación en el NAT puede ser útil para comprender los síntomas de dolor temporo-orofacial, parestesia de la articulación temporomandibular (ATM), posibles efectos secundarios de la cirugía de ATM y la eficacia del bloqueo del nervio auriculo-temporal para la anestesia regional de la articulación temporomandibular en Tailandeses.

Ultrasound-guided auriculotemporal nerve block for post-herpetic auriculotemporal neuropathy: A case report

Auriculotemporal neuropathy is a rare aetiology of orofacial pain. A 66-year old female patientpresented with severe, throbbing pain around the right ear after herpes zoster. The pain was consistentwith post-herpetic neuropathy and was not relieved by oral medications. To alleviate neuropathicpain, ultrasound-guided auriculotemporal nerve block was done. The pain was relieved completelyand the patient remained symptom-free until the last follow up at eight months after treatment. Withunderstanding of the anatomy and related symptoms of auriculotemporal nerve, auriculotemporalneuropathy can be controlled by ultrasound-guided auriculotemporal nerve block.

A typical Communicating Pattern between Branches of Mandibular Nerve: Clinical Significance & Review.

The posterior division of the mandibular nerve is known to have three branches in the infra temporal fossa namely lingual, inferior alveolar and auriculotemporal nerves. These branches mainly innervate oral and temporomandibular structures like tongue, lower gingiva, mandibular bone, teeth, and part of the lower lip, chin and salivary glands. We describe a case with unusual communications between these branches. The knowledge of any unusual communications among these branches is highly significant due to the various treatment procedures undertaken in the region.

Primary auriculotemporal neuralgia. Case report / Neuralgia do aurículotemporal primária. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Auriculotemporal neuralgia is an uncommon condition. Symptoms are brief severe pain attacks, especially in the temporal region. Although many cranial neuralgias are related to nervous compression, they may be present without identifiable etiologic factors. This study aimed at describing a case of primary auriculotemporal neuralgia and respective therapeutic approach. CASE REPORT: Male patient, 72 years old, presented for assistance reporting severe pain in left temporal region, described as shock and of very short duration. After clinical evaluation and imaging exams, no significant changes were detected. Patient has satisfactorily responded to carbamazepine. CONCLUSION: This case shows that auriculotemporal neuralgia has clinical presentation similar to other neuralgias. Diagnosis is primarily obtained by pain characteristics evaluation and exclusion of possible secondary causes.

RESUMO JUSTIFICATIVA E OBJETIVOS: A neuralgia do aurículotemporal é uma condição rara. Os sintomas consistem em ataques de dor intensa, de curta duração, sobretudo na região temporal. Embora muitos casos de neuralgias cranianas sejam relacionados à compressão nervosa, podem ocorrer sem fatores etiológicos identificáveis. O objetivo deste estudo foi descrever um caso de neuralgia auriculotemporal primária e respectiva conduta terapêutica. RELATO DO CASO: Paciente do gênero masculino, 72 anos, compareceu para atendimento relatando dor intensa em região temporal esquerda, descrita como choque, de curtíssima duração. Após avaliação clínica e exames de imagens, não foram detectadas alterações significativas. O paciente respondeu de forma satisfatória à carbamazepina. CONCLUSÃO: O caso descrito mostra que a aurículotemporal possui apresentação clínica semelhante àquela de outras neuralgias. O diagnóstico é obtido principalmente pela análise das características da dor e exclusão de possíveis causas secundárias.

An undocumented variation involving auriculotemporal nerve, inferior alveolar nerve and middle meningeal artery.

Auriculotemporal nerve typically has two roots, encircling the middle meningeal artery, one anterior to it and another posterior to it as well as maxillary artery. The middle meningeal artery is largest of the meningeal arteries, ascends between the sphenomandibular ligament and lateral pterygoid muscle and traverses between the roots of the auriculotemporal nerve before entering the cranial cavity through the foramen spinosum. The knowledge of the neurovascular relationships of the infratemporal region is significant in surgical practice. We present a case of unusual communication between the auriculotemporal nerve and inferior alveolar nerve together with an extraordinary change in relations with the middle meningeal artery. Some clinical implications that these relations may have on the development of the supplementary innervations and the surgical interventions in this region are discussed in this article.

Anomalous Bilateral Communication between the Inferior Alveolar Nerve and the Auriculotemporal Nerve: A Rare Variation

Branches of the posterior division of the mandibular nerve show various anomalous communications in the infratemporal region. Understanding such communication has relevance in the management of neuropathies and surgical procedures in this region. This study was conducted to explore such communicating branches, anticipating that they might provide information of clinical significance. A total of 15 human cadavers (30 infratemporal regions) were studied to explore such communicating branches in infratemporal region. The branches of the posterior division of the mandibular nerve were carefully dissected, and these branches were studied and analysed for any abnormal course. In one case, a rare type of bilateral communication between the auriculotemporal nerve and the inferior alveolar nerve, forming a loop with no association with any structure, was observed. It is possible that such communicating branches may be associated with delayed regression of the first arch vessels. The clinical implications of these anomalous communications require further detailed study for improved management of neuropathies and surgical procedures.

Anatomical Consideration of the Anterior and Lateral Cutaneous Nerves in the Scalp

To better understand the anatomic location of scalp nerves involved in various neurosurgical procedures, including awake surgery and neuropathic pain control, a total of 30 anterolateral scalp cutaneous nerves were examined in Korean adult cadavers. The dissection was performed from the distal to the proximal aspects of the nerve. Considering the external bony landmarks, each reference point was defined for all measurements. The supraorbital nerve arose from the supraorbital notch or supraorbital foramen 29 mm lateral to the midline (range, 25-33 mm) and 5 mm below the supraorbital upper margin (range, 4-6 mm). The supratrochlear nerve exited from the orbital rim 16 mm lateral to the midline (range, 12-21 mm) and 7 mm below the supraorbital upper margin (range, 6-9 mm). The zygomaticotemporal nerve pierced the deep temporalis fascia 10 mm posterior to the frontozygomatic suture (range, 7-13 mm) and 22 mm above the upper margin of the zygomatic arch (range, 15-27 mm). In addition, three types of zygomaticotemporal nerve branches were found. Considering the superficial temporal artery, the auriculotemporal nerve was mostly located superficial or posterior to the artery (80%). There were no significant differences between the right and left sides or based on gender (P>0.05). These data can be applied to many neurosurgical diagnostic or therapeutic procedures related to anterolateral scalp cutaneous nerve.

Topographical Relationship of the Superficial Temporal Vessels and the Auriculotemporal Nerve / 대한해부학회지

The anatomy of the superficial temporal vessels and the auriculotemporal nerve is important when harvesting various skin flaps in the temporal region. But Anatomy textbooks describe only one pattern of topographical relationship between these structures. A total of 65 Korean cadavers with 121 sides were used. We examined the topographical relationship between the superficial temporal artery and vein and the auriculotemporal nerve. And the bifurcating location of the superficial temporal artery and its distance from the lamina tragi were measured. The running patterns of the superficial temporal vessels were classified into 4 types according to their distance from each other and their parallelism. The artery and vein run parallel to each other in 61.2%. The running patterns of the superficial temporal vessels were classified into 5 types according to their anterior and posterior relationship. The artery runs anterior to the vein in most of the cases (72.7%). The topographic relationships of the auriculotemporal nerve and the superficial temporal vessels were classified into 6 types according to their anterior, posterior, superficial or deep position. In this classification, the relationship between the artery and the vein was not considered. The frequencies of 6 types were within 10~20%. The bifurcation of the artery occurred above the zygomatic arch in 85.3%. The superficial temporal artery ran 5.1 mm anterior to the tragus.