Anatomy, Head and Neck, Mental Nerve

John Nguyen; Hieu Duong.

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Last Update: August 10, 2020.

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Introduction
The nerve innervation in the face divides between the facial nerve (cranial nerve VII) and the
trigeminal nerve (cranial nerve V). The facial nerve provides the motor innervation to the
muscles that participate in facial expression. The trigeminal nerve is the source of sensory
innervation to the face. Along with sensory innervation, the trigeminal nerve also provides motor
innervation to the muscles used for mastication.
The sensory map of the face can further divide between the three main branches of the trigeminal
nerve. The first branch that arises from the trigeminal nerve is the ophthalmic nerve (CN V1).
The ophthalmic nerve provides sensory innervation to the eye region and parasympathetic
innervation. The second branch of the trigeminal nerve is the maxillary nerve (CN V2). The
sensory territory of the maxillary nerve is mainly below the eye extending to the upper lip. The
last branch from the trigeminal nerve is the mandibular nerve (CN V3). The mandibular provides
motor innervation to the muscles of mastication. The sensory innervation territory of the
mandibular nerve correlates with the mandibular bone. These regions include the jawline, lower
lip, and chin mainly.
The branches of the trigeminal nerves will further branch into different nerves to provide sensory
innervation to their sensory territories; for example, the mandibular nerve branches into the
alveolar nerve. The alveolar nerve will travel within the mandible bone and then branches into
the mental nerve.[1] The mental nerve will be responsible for providing sensory innervation to
the lower lip and the chin region.
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Structure and Function

As the trigeminal nerve exits the pons, it will divide into the ophthalmic nerve, the maxillary
nerve, and the mandibular nerve. The mandibular nerve will exit the cranial valve via the
foramen of ovale. The mandibular nerve eventually branches into the inferior alveolar nerve. The
inferior alveolar nerve travels in the alveolar foramen. Once the inferior alveolar nerve gets near
mental foramen. The inferior alveolar nerve branches into the mental nerve. The mental nerve
will provide sensory innervation to the anterior territory of the chin, lower lip, and the
buccal gingivae. The mental nerve divides into three branches. The division of the mental nerve
occurs beneath the depressor anguli oris muscle. The first branch of the mental nerve descends
toward the chin to give sensory innervation to the skin of the anterior chin. The other two
branches will ascend to provide sensory innervation to the lower lip and buccal gingivae around
the premolar teeth.[1][2]
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Embryology
During embryology, the nerves derive from the ectodermal germ layer. The ectodermal germ
layer that participates in nervous tissue formation further subdivides into neuroectoderm and
neural crest cells. The nerves that are in the central nervous system will develop from
neuroectoderm while the peripheral nerves will originate from the neural crest cells. The
trigeminal nerve and its branches will develop from the neural crest cells, making the mental
nerve a derivative of neural crest cells.
The development of the trigeminal nerve in the face derives from the brachial apparatus. The
brachial arches will develop into the muscles, vessels, bone, and nerves in the face and neck. The
brachial arch is made up mainly of mesoderm and neural crest cells. The first brachial arch
develops into the mandibular nerve. The mandibular nerve will give rise to the inferior alveolar
nerve, which branches into the mental nerve.
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Blood Supply and Lymphatics

The blood supply to the mental nerve will come from four main arteries:
• Inferior labial artery
• Mental artery
• Submental artery
• Inferior alveolar artery
These arteries are the main artery that perfuses the mental nerve and its sensory territory. The
vascular network around the lips forms from many anastomoses. The network of vessels can
provide collateral blood flow to the lips and chin regions.
The lymphatic drainage for the mental nerve and its sensory territory is towards the submental
lymph nodes or the submandibular lymph nodes. These lymph nodes will eventually drain back
into the central circulation. The right side of the chin will drain back into the central circulation
via the right lymphatic duct. The left side of the chin will drain back into the central circulation
via the thoracic duct.
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Nerves
The mental nerve is one of the branches of the inferior alveolar nerve (branch of the mandibular
nerve). The sensory innervation of the mental nerve may have some small overlap with the
contralateral mental nerve. The sensory innervation of the mental nerve divides between three
smaller branches. One of the branches from the mental nerve will innervate the skin on the chin.
The other two nerves provide sensory innervation to the gingivae, the mucosa, and the lower lip.
The mental nerve also has some communication with the facial nerve.
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Muscles
The only muscle that the mental nerve has an anatomical association with is the depressor anguli
oris muscle. As the mental nerve exits the mental foramen, it divides into its three branches
underneath or posterior to the depressor anguli oris muscle.
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Physiologic Variants
The branching of the mental nerve may vary slightly. In some individuals, there may be more or
fewer branches that come from the mental nerve. In some individuals, there are multiple mental
foramina. The various foramina lead to variations in the branches of the mental nerve exiting.
Even with the differences in the branching of the mental nerve, the sensory territory is
consistent.[3][4]
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Surgical Considerations
The knowledge of the mental nerve location and its sensory territory is essential in surgery.
Damage to the mental nerve is avoidable during surgery.
In plastic surgery, blocking of the mental nerve is common during chin reconstructive surgeries.
The surgeon may choose to inject a local anesthetic into the mental nerve to reduce the sensation
of pain. In mentoplasties and other chin surgeries, the patient may be awake — the nerve block
aids in safe and successful surgery with reduced potential complications. The surgeon may also
block the mental nerve block in jaw and lower lip surgeries.[5][6]
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Clinical Significance
The mental nerve can be injected with an anesthetic when it comes to repairing lacerations of the
lower lip and soft tissues of the lower face. Proper anesthetic is necessary to prevent tissue
distortion and pain.[6][7] The nerve block may prevent the need to inject a local anesthetic into
the tissue itself. The injection of local anesthetic into the tissue can distort the tissue leading to
potentially poor aesthetic appearance during suturing. However, it is important to know that a
mental nerve block does not provide adequate anesthesia for dental work or soft tissue of the
upper face. When properly performed, a mental nerve block can significantly lower the pain in
the mental nerve sensory territory.[8][9][10]
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Other Issues
Since the mental nerve is a branch of the inferior alveolar nerve. Any damage or aesthetic
affecting the inferior alveolar nerve will also affect the mental nerve's sensory territory. While
damage or compromise of the mandibular nerve or the trigeminal nerve will also affect the
sensory area of the mental nerve.[8]
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Questions
To access free multiple choice questions on this topic, click here.

Figure
Mental nerve. Image courtesy O.Chaigasame

ARTICULO ORIGINAL: https://www.ncbi.nlm.nih.gov/books/NBK546630/

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References
1.
 Lee MH, Kim HJ, Kim DK, Yu SK. Histologic features and fascicular arrangement of the
inferior alveolar nerve. Arch. Oral Biol. 2015 Dec;60(12):1736-41. [PubMed]
2.
Iwanaga J, Saga T, Tabira Y, Nakamura M, Kitashima S, Watanabe K, Kusukawa J,
Yamaki K. The clinical anatomy of accessory mental nerves and foramina. Clin
Anat. 2015 Oct;28(7):848-56. [PubMed]
3.
Costa ED, Peyneau PD, Visconti MA, Devito KL, Ambrosano GMB, Verner FS. Double
mandibular canal and triple mental foramina: detection of multiple anatomical variations
in a single patient. Gen Dent. 2019 Sep-Oct;67(5):46-49. [PubMed]
4.
Goyushov S, Tözüm MD, Tözüm TF. Assessment of morphological and anatomical
characteristics of mental foramen using cone beam computed tomography. Surg Radiol
Anat. 2018 Oct;40(10):1133-1139. [PubMed]
5.
Tan FF, Schiere S, Reidinga AC, Wit F, Veldman PH. Blockade of the mental nerve for
lower lip surgery as a safe alternative to general anesthesia in two very old patients. Local
Reg Anesth. 2015;8:11-4. [PMC free article] [PubMed]
6.
Moskovitz JB, Sabatino F. Regional nerve blocks of the face. Emerg. Med. Clin. North
Am. 2013 May;31(2):517-27. [PubMed]
7.
Tanner RB, Hubbell JAE. A Retrospective Study of the Incidence and Management of
Complications Associated With Regional Nerve Blocks in Equine Dental Patients. J Vet
Dent. 2019 Mar;36(1):40-45. [PubMed]
8.
Smith RM, Hassan A, Robertson CE. Numb Chin Syndrome. Curr Pain Headache
Rep. 2015 Sep;19(9):44. [PubMed]
9.
Betz D, Fane K. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 26,
2020. Mental Nerve Block. [PubMed]
10.
Syverud SA, Jenkins JM, Schwab RA, Lynch MT, Knoop K, Trott A. A comparative
study of the percutaneous versus intraoral technique for mental nerve block. Acad Emerg
Med. 1994 Nov-Dec;1(6):509-13. [PubMed]