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.
| Origin | Inferior alveolar nerve just before it enters the mandibular foramen |
|---|---|
| Course | Pierces the sphenomandibular ligament, descends in the mylohyoid groove on the medial surface of the ramus, and runs on the inferior surface of mylohyoid to reach the anterior belly of digastric |
| Motor | |
| Sensory |
|
The nerve to mylohyoid is a recognised accessory pathway to the lower molars, entering the mandible through small lingual foramina, which explains some failures of a technically correct inferior alveolar nerve block. When the standard block fails, a supplementary lingual infiltration below and behind the molar, or intrapulpal anaesthesia, usually completes the anaesthesia. The nerve is at risk in sagittal split osteotomy of the mandible, in submandibular approaches to mandibular fractures and in floor of mouth resections for oral cancer.
Persistent pain during lower molar treatment despite an inferior alveolar block reflects accessory supply from the nerve to mylohyoid and is corrected by lingual infiltration at the molar root level or intrapulpal injection.
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