The nerve to mylohyoid arises from the inferior alveolar nerve just before it enters the mandibular foramen. It descends in the mylohyoid groove on the medial surface of the mandibular ramus, passes beneath the mylohyoid muscle, and supplies the mylohyoid and the anterior belly of the digastric. It may also carry sensory fibres to the chin skin and occasionally provides an anomalous dental supply to the lower incisors.
The nerve to mylohyoid is clinically significant in dentistry as an accessory pathway that can provide incomplete anaesthesia during inferior alveolar nerve block, particularly for the lower molars. When conventional IAN block fails, supplementary injection along the mylohyoid nerve pathway or directly into the buccal sulcus at the molar level may improve anaesthesia. The nerve is also identified during mandibular fracture surgery through submandibular approaches and in floor-of-mouth dissections for oral cavity cancer.
Persistent pain during lower molar dental procedures despite IAN block reflects accessory innervation via the nerve to mylohyoid, corrected by additional infiltration into the lingual sulcus at the molar root level or directly into the pulp chamber of the tooth.
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