The sphenomandibular ligament is a medial accessory ligament of the TMJ, running from the spine of the sphenoid to the lingula of the mandible beside the mandibular foramen. It is a remnant of the sheath of Meckel's cartilage. The inferior alveolar nerve and vessels pass between the ligament and the ramus to enter the mandibular foramen, making the ligament the medial guide for inferior alveolar nerve block injections.
| Origin | Spine of the sphenoid bone |
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| Insertion | Lingula of the mandible at the mandibular foramen |
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Acts as a suspensory accessory ligament of the mandible and helps limit excessive opening and lateral movement.
The inferior alveolar nerve block is directed toward the mandibular foramen guided by the sphenomandibular ligament as the medial border. The needle is walked along the medial ramus to the foramen. Incorrect block technique placing the needle too posterior can lacerate the pterygoid venous plexus deep to the ligament.
Haematoma formation in the pterygoid space behind the sphenomandibular ligament from inadvertent pterygoid plexus penetration during dental nerve block, producing progressive jaw restriction over 24 hours.
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