Korean J Pain.  2023 Oct;36(4):465-472. 10.3344/kjp.23186.

New insight into the mandibular nerve at the foramen ovale level for percutaneous radiofrequency thermocoagulation

• Zhu PB
• Kim YD
• Jeong HY
• Yang M
• Won HS

• KMID: 2546709
• DOI: http://doi.org/10.3344/kjp.23186

Abstract

Background
Percutaneous radiofrequency thermocoagulation (RFTC) has been widely utilized in the management of trigeminal neuralgia. Despite using image guidance, accurate needle positioning into the target area still remains a critical element for achieving a successful outcome. This study was performed to precisely clarify the anatomical information required to ensure that the electrode tip is placed on the sensory component of the mandibular nerve (MN) at the foramen ovale (FO) level.
Methods
The study used 50 hemi-half heads from 26 South Korean adult cadavers.
Results
The cross-sectioned anterior and posterior divisions of the MN at the FO level could be distinguished based on an irregular boundary and color difference. The anterior division was clearly brighter than the posterior one. The anterior division of the MN at the FO level was located at the whole anterior (38.0%), anteromedial (6.0%), anterior center (8.0%), and anterolateral (22.0%) parts. The posterior division was often located at the whole posterior or posterolateral parts of the MN at the FO level. The anterior divisions covered the whole MN except for the medial half of the posterolateral part in the overwrapped images of the cross-sectional areas of the MN at the FO level. The cross-sectional areas of the anterior divisions were similar in males and females, whereas those of the posterior divisions were significantly larger in males (P = 0.004).
Conclusions
The obtained anatomical information is expected to help physicians reduce unwanted side effects after percutaneous RFTC within the FO for the MN.

Keyword

Foramen Ovale; Mandibular Nerve; Pain; Physicians; Radiofrequency Ablation; Sensation; Trigeminal Nerve; Trigeminal Neuralgia

Figure

• 

  Fig. 1 Photographs showing the methodology for investigating the cross-sectional morphology of the mandibular nerve (MN) at the foramen ovale (FO) level. (A) The MN and all of its branches are exposed in the infratemporal fossa after removing the skin, subcutaneous tissue, zygomatic arch, ramus of mandible, masticatory muscles, and maxillary vessels, etc. A red-colored dotted circle indicates the location of the FO. (B) After cutting transversely the short trunk close to the FO, the cross-sectional area of each division could be distinguished by an irregular boundary and color in most of the specimens. The posterior division (asterisk) is clearly darker than the anterior one. (C) The boundary of each division of the MN is manually drawn using a transparent film on the image. AD: anterior division, Ant: anterior, ATN: auriculotemporal nerve, BN: buccal nerve, DTN: deep temporal nerve, IAN: inferior alveolar nerve, Lat: lateral, LN: lingual nerve, LPN: nerve to lateral pterygoid muscle, LPP: lateral plate of the pterygoid process, Med: medial, MLN: nerve to mylohyoid muscle, MsN: masseteric nerve, PD: posterior division, Post: posterior.

• 

  Fig. 2 Schematic drawing of the territory of the anterior division in the cross-sectional area of the mandibular nerve (MN) at the foramen ovale (FO) level in males (A), females (B), and all specimens (C). Dashed lines indicate imaginary lines quadrisecting the cross-sectional area of the MN. Darker color indicates more-overwrapped areas of the anterior division. Unfilled areas indicate the posterior division of the MN where the anterior division is not invaded. Ant: anterior, Lat: lateral, Med: medial, Post: posterior.

• 

  Fig. 3 A fluoroscopic image showing an optimal needle positioning in the patient with TN during percutaneous RFTC, and enlarged view of which is shown in the rectangle. A dotted circle, vertical and horizontal lines indicate the FO itself and imaginary lines quadrisecting the area of the FO, respectively. TN: trigeminal neuralgia, RFTC: radiofrequency thermocoagulation, FO: foramen ovale.

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