The mylohyoid nerve is a branch of the inferior alveolar nerve arising just before or as the inferior alveolar nerve enters the mandibular foramen. It descends in the mylohyoid groove on the medial mandibular surface and supplies motor innervation to the mylohyoid muscle and the anterior belly of the digastric. It also carries sensory fibres to the skin of the chin and submental triangle.
The mylohyoid nerve is the most common source of accessory innervation to the lower molars, explaining why inferior alveolar nerve block (IAN block) occasionally fails to achieve complete anaesthesia of the lower molars despite a technically correct block. The mylohyoid accessory branch can supply the mandibular first molar pulp through accessory buccal foramina in the region of the molar roots. Supplementary buccal infiltration or intrapulpal anaesthesia overcomes this accessory supply. The mylohyoid nerve is at risk during mandibular sagittal split and during floor of mouth tumour resection.
The mylohyoid nerve provides accessory innervation to the lower first molar through buccal foramina in 30% of individuals, causing incomplete anaesthesia after standard inferior alveolar nerve block; supplementary buccal mylohyoid infiltration at the molar region restores complete analgesia for lower molar procedures.
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