Important Pathways to recognize prior to understanding clinical complications and scenarios:
Lingual Nerve Pathway:
CNV3 → Lingual Nerve (+Chorda Tympani from Facial Nerve) →Submandibular Ganglion
Inferior Alveolar Nerve Pathway:
CNV3 Mandibular Nerve → Inferior Alveolar Nerve →Inferior Dental Nerves → Mental Nerve (+ Nerve to Mylohyoid)
Lingual Artery Pathway:
External Carotid Artery→ Lingual Artery → Sublingual Artery, Deep Lingual Artery, Dorsal Lingual Artery
Inferior Alveolar Artery Pathway:
External Carotid Artery → Maxillary Artery → [Mandibular Foramen] → Inferior Alveolar Artery → [Mental Foramen] → Mental Artery
Nerves surrounding Maxillary Sinus Pathway:
CN V2 → Maxillary Nerve → [Foramen Rotundum] → into Pterygopalatine …show more content…
• Fistula develops (thin membrane) in skin, or oral mucosa to contain infection locally.
• *Can spread to Paranasal Sinus via Blood or Lymphatics
• *Maxillary Sinus = Caused by Upper Resp. Infections
Via Blood System: (Potentially Fatal)
• Cavernous Sinus → 1) Pterygoid Plexus, 2) Superior Ophthalmic Vein→Facial Vein → 1) Posterior Superior/ 2) Inferior Alveolar Veins / 3) Superior/ 4) Inferior Labial Veins
• Valves prevent retrograde backflow into CS, thus infections initiate inflammatory responses, increases blood stasis, thrombus formation, and extravascular fluid pressure.
• This can reverse direction of venous blood flow, causing infection into venous sinus causing → Cavernous Sinus Thrombosis. Increase in pressure can also Damage the cranial nerves that run through/on the walls of the CS (CN 3, 4, 5, 6)
• Can also lead to meningitis
Via Pterygoid Plexus Damage: Cause by poor administration of posterior superior alveolar anesthetic …show more content…
- TMJ Injuries (Needle injection, Bur or Implant perforation, Orthodontic and orthognathic procedures) o Trigeminal nerve innervates the TMJ, majority of the face and neck. o Blood flow to the Ant. 2/3 of the brain via the dura mater
- Dental Root Resorption (Orthodontic procedures) o Breakdown or destruction of the root structure of a tooth. o Caused by improper pressure placed on the root surface
- Instruments Broken in Canals o Infection/Abscess/Sepsis
- Air embolisms o Produced by inadvertent injection of a mixture of air and water, passing through the dental drill, directly into the mandible to the facial and pterygoid plexus veins and finally to the superior vena cava and right atrium. o Cardiac arrest/collapse, cyanosis hypoxaemia, and hypercapnia o Irreversible brain damage
- Substandard crown, bridge
Lingual Nerve Pathway:
CNV3 → Lingual Nerve (+Chorda Tympani from Facial Nerve) →Submandibular Ganglion
Inferior Alveolar Nerve Pathway:
CNV3 Mandibular Nerve → Inferior Alveolar Nerve →Inferior Dental Nerves → Mental Nerve (+ Nerve to Mylohyoid)
Lingual Artery Pathway:
External Carotid Artery→ Lingual Artery → Sublingual Artery, Deep Lingual Artery, Dorsal Lingual Artery
Inferior Alveolar Artery Pathway:
External Carotid Artery → Maxillary Artery → [Mandibular Foramen] → Inferior Alveolar Artery → [Mental Foramen] → Mental Artery
Nerves surrounding Maxillary Sinus Pathway:
CN V2 → Maxillary Nerve → [Foramen Rotundum] → into Pterygopalatine …show more content…
• Fistula develops (thin membrane) in skin, or oral mucosa to contain infection locally.
• *Can spread to Paranasal Sinus via Blood or Lymphatics
• *Maxillary Sinus = Caused by Upper Resp. Infections
Via Blood System: (Potentially Fatal)
• Cavernous Sinus → 1) Pterygoid Plexus, 2) Superior Ophthalmic Vein→Facial Vein → 1) Posterior Superior/ 2) Inferior Alveolar Veins / 3) Superior/ 4) Inferior Labial Veins
• Valves prevent retrograde backflow into CS, thus infections initiate inflammatory responses, increases blood stasis, thrombus formation, and extravascular fluid pressure.
• This can reverse direction of venous blood flow, causing infection into venous sinus causing → Cavernous Sinus Thrombosis. Increase in pressure can also Damage the cranial nerves that run through/on the walls of the CS (CN 3, 4, 5, 6)
• Can also lead to meningitis
Via Pterygoid Plexus Damage: Cause by poor administration of posterior superior alveolar anesthetic …show more content…
- TMJ Injuries (Needle injection, Bur or Implant perforation, Orthodontic and orthognathic procedures) o Trigeminal nerve innervates the TMJ, majority of the face and neck. o Blood flow to the Ant. 2/3 of the brain via the dura mater
- Dental Root Resorption (Orthodontic procedures) o Breakdown or destruction of the root structure of a tooth. o Caused by improper pressure placed on the root surface
- Instruments Broken in Canals o Infection/Abscess/Sepsis
- Air embolisms o Produced by inadvertent injection of a mixture of air and water, passing through the dental drill, directly into the mandible to the facial and pterygoid plexus veins and finally to the superior vena cava and right atrium. o Cardiac arrest/collapse, cyanosis hypoxaemia, and hypercapnia o Irreversible brain damage
- Substandard crown, bridge