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Lingual nerve anaesthesia during inferior alveolar block — ORE Part 1 MCQ

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ModerateApplied Dental SciencesLingual nerve anaesthesia during inferior alveolar blockORE Part 1

During an inferior alveolar nerve block for a mandibular molar, a patient develops ipsilateral numbness of the anterior two-thirds of the tongue and altered taste. The solution was deposited in the pterygomandibular space. Which explanation is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — The lingual nerve lies near the inferior alveolar nerve in this space

Explanation lettering: E = shown as A · A = shown as C · C = shown as D · D = shown as E

C is correct. The lingual nerve and inferior alveolar nerve both traverse the pterygomandibular space in close proximity, so local anaesthetic intended for an inferior alveolar block may also anaesthetise the lingual nerve. The lingual nerve supplies general sensation to the anterior two-thirds of the tongue and conveys chorda tympani taste fibres; therefore, numbness with altered taste is expected. A is incorrect because the hypoglossal nerve is motor to the tongue muscles. B is incorrect because the mental foramen transmits the mental nerve, not the chorda tympani. D is incorrect because the long buccal nerve supplies buccal mucosa and gingiva, not taste from the tongue. E is incorrect because the facial nerve trunk is not located in the pterygomandibular space.

Reference: Iwanaga J, et al. Anatomical Study of the Lingual Nerve and Inferior Alveolar Nerve in the Pterygomandibular Space: Complications of the Inferior Alveolar Nerve Block. Cureus. 2018. https://pubmed.ncbi.nlm.nih.gov/30338184/