Bilateral communication between the mylohyoid and lingual nerves: Clinical implications

Although variations in the course of the mylohyoid nerve (MHN) in relation to the mandible are frequently found on dissection but these anatomical variations have not been conclusively described in the anatomical or surgical literature. However, it is a well-known fact that variations in the branching pattern of the mandibular nerve frequently account for the failure to obtain adequate anesthetic effect in routine oral and dental procedures and also for the unexpected injury to the branches of the nerves during surgery. Furthermore, anatomical variations might be responsible for unexpected and unexplained symptoms after a certain surgical procedures and in some cases of refractory neuralgias. We describe the presence of a rare bilateral communicating branch between the MHN and lingual nerves (LN) in an adult male cadaver, with a brief discussion of its anatomical, clinical and surgical implications as well as its possible role in the sensory innervations of the tongue. The present case reinforces the idea of a communicating branch between the MHN and LN, indicating that some of the sensory components of the MHN, instead of innervating the teeth or chin skin, might also innervate the tongue. This anatomical variation mandates to update the knowledge and awareness among surgeons and anesthesiologists who are frequently involved in oro-surgical procedures and nerve blocks of the face for various neuralgias so as to avoid any un-anticipated nerve injury.