Inferior Alveolar Research Articles

Modification of the sagittal split ramus technique

Many modifications and variations of the original sagittal split procedure have been performed since its inception. Many of these procedures do not involve the full width of the ascending ramus in an attempt to reduce blood loss and nerve damage. These risks of damage can be reduced by using the technique and instrumentation described, while at the same time the surgeon is allowed use of the full width of the ascending ramus. The surgical splitting of the ascending ramus of the mandible in the sagittal plane was first described by Obwegeser in 1957.’ Dal Pont2 described his modification of Obwegeser’s technique in 1961. Since then many modifications and approaches have been published.3-6 Common complaints from surgeons about the sagittal splitting procedure include an extended length of operating time, an increased risk of injury to the inferior alveolar nerve, excessive bleeding and edema, infection, and relapse. Comparisons between the sagittal split and other techniques,7 however, have shown little difference in postoperative problems except for an increased incidence of inferior alveolar nerve damage and greater volume of blood loss with the sagittal ramus split technique. Most modifications of the Obwegeser procedure represent attempts to negate the aforementioned difficulties with the original technique. Inability to achieve good visibility increases the difficulty of the procedure, thereby increasing the risk of damage to the inferior alveolar nerve and artery. This represents a major cause of increased operative bleeding and postoperative paresthesia. Epke$ believed that operating distally to the lingula caused additional nerve damage, and he therefore used essentially a Hunsuck modification. In correction of simple prognathism, the vertical ramus osteotomy and the Hunsuck modification generally provide adequate bony contact. In correction of retrognathism, apertognathism, or prognathism with an open bite component, however, the Hunsuck modification may not result in an adequate

The inferior alveolar artery of the rabbit--from its origin to the mandibular foramen.

The inferior alveolar artery of the rabbit--from its origin to the mandibular foramen.

Early tissue reactions after circulatory and skeletal damage to the mandible of the rat.

Skeletal and circulatory damage in the form of a fracture of the mandible, proximal to the entry of the inferior alveolar artery and other perforantes, alone or combined with unilateral or bilateral mucoperiosteal extirpation, was inflicted on growing young rats. A morphological study of the tissue changes in the bone, dental tissues and soft tissues was performed. Cutting of the nutrient vessels together with extirpation of the periosteum was followed after 10 days by extensive infarction of the incisor pulp, the odontoblasts and the apical part of the enamel organ. The bone was damaged centrally in the mandibular corpus and at the lower border of the ramus, and was partly resorbed during the experimental period. The periodontium showed dilated vessels, but was not damaged. The pulps of the three molars showed numerous dilated vessels but were otherwise not damaged. The oral mucosa, bone marrow, peripheral nerve tissue and peripherally situated bone were not altered. In the animals after fracture alone, oedema of the incisor pulp was present, but infarction did not occur with certainty. A similar bone damage as with mucoperiosteal extirpation was present. The incisor with its dentin and enamel-forming cells was most sensitive to circulatory disturbances due to its central location, while the gingivoperiodontal, mucoperiosteal and midline circulatory systems could nourish the peripheral parts of the mandible. The dependence of the different nutrient systems to bone and dental tissues is discussed.

Normal and retrograde blood supply to the body of the mandible in the dog. II.: The role played by periosteo-medullary and symphyseal anastomoses

An experimental study was carried out in 8 dogs to delineate the blood supply to the body of the mandible under normal conditions and when the central (medullary) circulation was blocked. A vascular blocking technique combined with selective arterial perfusion using different colored perfusaes was used. The results were based on an evaluation of cleared specimens, microradiography and histology. Under normal conditions, the inferior alveolar artery was shown to be the sole source of perfusate to the entire mandibular body, marginal gingiva and the subperiosteal layer, without any contribution from facial artery branches. Several perfused symphyseal anastomoses were found. When the medullary circulation was blocked, retrograde perfusion was evident only in the medullary bone of the frontal region 30 min. after blocking. Marked periosteal and symphyseal vascularity and an increased medullary perfusion were seen 3 days later. 30 days after vascular blocking, perfusion was demonstrated throughout the entire bone including dental pulps. The facial artery was found to be the source of the retrograde perfusion through symphyseal and periosteo-medullary anastomoses in cases with blocked central (medullary) circulation.

The facial artery of the dog.

The course, branching and distribution territories of the facial artery of the dog were studied by the acryl plastic injection method. In general, the facial artery was found to arise from the external carotid between the points of origin of the lingual and posterior auricular arteries. It ran anteriorly above the digastric muscle and gave rise to the styloglossal, the submandibular glandular and the pterygoid branches. The artery continued anterolaterally giving off the digastric, the inferior masseteric and the cutaneous branches. It came to the face after sending off the submental artery, which passed anteromedially, giving off the digastric and mylohyoid branches, on the medial surface of the mandible, and gave rise to the sublingual artery. The gingival, the genioglossal and sublingual plical branches arose from the vessel, while the submental artery gave off the geniohyoid branches. Posterior to the mandibular symphysis, various communications termed the sublingual arterial loop, were formed between the submental and the sublingual of both sides. They could be grouped into ten types. In the face, the facial artery gave rise to the mandibular marginal, the anterior masseteric, the inferior labial and the buccal branches, as well as the branch to the superior, and turned to the superior labial artery. As variations, the submental artery arose directly from the external carotid, and an accessory inferior alveolar artery arose from the facial in a few cases.

Blood Supply of the Rat Periodontal Space During Amelogenesis as Studied by the Injection Replica SEM Method

Distribution of blood vessels at the labial periodontal space of the rat lower incisor teeth was studied, using Mercox-resin vascular casts, which were coated with gold-palladium and observed in a scanning electron microscope (SEM). Three different layers were identified in the vascular bed of the periodontium. In the inner layer the enamel organ was supplied by a blood capillary network that changed from a circular mesh to a ladder-like pattern during amelogenesis. The middle layer was supplied by small arteries and arterioles. Small arteries originated from the inferior alveolar artery; arterioles, arising from them, became blood capillaries. In the outer layer, the sinusoid veins continued with the blood capillaries which ran into the proximal and the distal sites of the inner layer. This venous layer is located near the alveolar bones. As capillary networks change in pattern during amelogenesis, the circular mesh is considered convenient to provide the required materials for the proliferation and differentiation of inner enamel epithelial cells as well as for early enamel matrix formation, whereas the ladder pattern seems suitable to supply numerous organic or inorganic materials for the advanced enamel matrix formation and calcification.

Clinical observations on chronic osteomyelitis of the mandible

Chronic mandibular osteomyelitis (CMO) is an inflammatory disease that is resistant to treatment. This paper describes 16 cases of CMO that were treated in our hospital between 1986 and 1992. The discussion includes various methods of treatment. An insufficient inferior alveolar artery (IAA) blood supply as determined by angiography also played a role in CMO. In the above cases, CMO was caused by several different dental diseases.1. Ten cases were diagnosed histopathologically as supprative osteomyelitis; the remaining 6 cases were determined to be sclerosing osteomyelitis. Female patients in their fourth decade accounted for the biggest subgroup. The most frequent tooth involved was the mandibular molar.2. Patients with supprative osteomyelitis showed characteristic symptoms: a) short duration of disease, b) local infection, c) pus discharge, and d) fistula formation. Sequestrectomy was most frequently used as a corrective procedure. Decortication combined with sequestrectomy was used in all cases with sclerotic changes of bone cortex.3. Sclerosing osteomyelitis was clinically characterized by a long duration of disease, diffuse sclerotic changes on X-ray, and associated trismus. Among 4 cases of sclerosing osteomyelitis that underwent angiography of the IAA, 3 cases showed deformities. Therefore, angiography seemed to be a useful procedure to forecast the prognosis because it evaluates the blood supply into the mandible. Consequently, a decreased blood supply might indicate a poor response to antibiotic therapy. In cases without IAA deformity, decorticotomy alone was sufficient for treatment. On the other hand, in the cases of IAA deformity, treatment included a combination of intra-arterial antibiotic infusion and decorticotomy or saucerization.The above procedures resulted in cure in all but 1 case of CMO.

The cranial nerves of the colubrid snakes Elaphe and Thamnophis

AbstractThe cranial nerves of adult Elaphe obsoleta quadrivittata and late embryonic Thamnophis ordinoides, were studied, respectively, by dissection and by microscopic examination of serial sections. There are 11 cranial nerves in these snakes; the spinal accessory (XI) cannot be identified. In general, the nerves are similar to those of lizards. Certain nerves usually combine into a trunk: the oculomotor (III), trochlear (IV), ophthalmic division (V1) and abducens (VI), form the ocular trunk, whereas the glossopharyngeal (IX), vagus (X), and hypoglossal (XII), compose the craniocervical trunk. No terminal nerve is found. The first nerve exists as the independent vomeronasal and olfactory proper nerves. There is a large lagenar (auditory) part of the eighth nerve. The three main divisions of the trigeminal nerve (V) have the widest distribution in the head. In addition, there is a pterygoid division (V4) in snakes, innervating the muscles of the upper jaw series of bones. The V4 is best developed in snakes among all vertebrates. A chorda tympani of VII is present. The glossopharyngeal is a small nerve. The vagus comprises a large laryngeal branch and a larger visceral nerve to the trunk. The hypoglossal heavily innervates the tongue musculature.There are four cephalic parasympathetic ganglia: ciliary, preorbital, infraorbital, and inferior alveolar. Several of the ganglia may also include sympathetic cell bodies. The ciliary ganglion innervates intraocular smooth muscle, whereas the other ganglia supply the various cephalic glands. No distinct superior cervical sympathetic ganglion is recognized. Sympathetics distribute in the head through the craniocervical trunk and its communications with the facial and trigeminal nerves.

The trigeminal depressor response: A novel vasodepressor response originating from the trigeminal system

Electrical stimulation within discrete sites of the spinal trigeminal complex in anesthetized or decerebrated rabbits results in arterial hypotension, often over 50 mm Hg, bradycardia of up to 60 beats/min, apnea, and gastric hypermotility, collectively termed the trigeminal depressor response (TDR). The threshold for the TDR is ⪕ 10 μA and is graded up to 3–6 times threshold. It can only be elicited by trains of stimuli of low frequency (0.5–20 Hz); at 50 Hz the response disappears or becomes pressor. The bradycardia is only abolished by bilateral vagotomy combined with β-adrenergic blockade, and thus results from combined excitation of cardio-vagal and inhibition of cardiac sympathetic nerves. The hypotension is unassociated with changes in cardiac output, does not change after blockade of the bradycardia, but disappears after α-adrenergic blockade and hence is entirely attributable to inhibition of ongoing sympathetic vasoconstrictor nerve activity. Below threshold stimulation the TDR can only be elicited from the root entry zone of the Vth nerve, from dorsal portions of the spinal tract of the Vth nerve, and to portions of the nucleus of the spinal tract, notably the nucleus caudalis. A TDR of reduced magnitude can also be elicited by low frequency stimulation of numerous branches of the Vth nerve arising from all three divisions and including the supra-and infra-orbital, the inferior alveolar, and lingual nerves. Bilateral electroytic lesions of the nucleus tractus solitarii at the obex, with complete abolition of baroreceptor reflexes from carotid sinus and aortic depressor nerves, fail to alter the TDR elicited from the brain or from branches of the Vth nerve, or the vasodepressor responses elicited by electrical stimulation of the central ends of the IXth and Xth cranial nerves transescted distal to the branches of baro-receptor nerves. In contrast, caudal lesions of the trigeminal complex abolish the TDR elicited from brain and Vth nerve and substantially reduces the vasodepressor responses from the IXth and Xth nerves, without altering baroreceptor reflexes. We conclude that the TDR represents a heretofore recognized vasodepressor response dependent upon the spinal trigeminal complex which is at least in part anatomically distinct from pathways subserving arterial baroreceptor and somatic vaso-depressor reflexes. The TDR can be reflexly elicited from widely distributed but yet unidentified receptors innervated by branches of the Vth and of the IXth and Xth cranial nerves other than those innervating arterial baroreceptors. It is of unknown function, but may be related to pain mechanisms.

Interruption of the arterial inferior alveolar flow and its effects on mandibular collateral circulation and dental tissues.

The interruption of circulation through the inferior alveolar artery was followed by the establishment of a fast retrograde blood flow through the vessel. The mental artery and the mandibular branch of the sublingual artery were the main vessels to contribute to that flow. No histopathologic changes were found in the experimental hemimandibles; however, temporary regressive changes were found in the dental pulps of molars.

犬の下顎動脈の機能的分布について

Forty adult dogs were prepared for this experiment. They were ansethetized by Ravonal and infused with 10% gelatine solution with addition of india ink through the left ventricle or proximal stem of the ligated artery. After decapitation, fixation and decalcification, both of the mandibles were cut into 5 blocks and the posterior cutting surfaces of anterior 4 blocks were observed under a binocular microscope. The obtained results are as the following : 1. The ligature of the unilateral inferior alveolar artery showed in the distal part than the ligated point that the more posterior part of the experimented mandible has the lower infusion grade, but the anterior part was compensated by the contralateral artery. 2. The ligature of the unilateral lingual and facial artery showed a little low infusion grade in the periosteal layer. 3. The ligature of the maxillary artery shows much lower density than that of the inferior alveolar artery. 4. The ligature of the common carotid artery resulted in summation of plural ligatures of its branches. 5. The ligature of two kinds of unilateral arteries showed less tensely infused areas corresponding to their supplying areas. 6. The selective infusion resulted in the lower grade of infusion but the spreading area was wider than the arterial supply. 7. From these experiments, functional compensation areas of the arteries were wider than anticipation from the morphological distribution.

Blood supply of the human fetal mandible.

AbstractGross anatomic and radiologic studies of the blood supply to the human mandible of the full‐term fetus and newborn infant were performed on 22 specimens ranging from 320–538 mm crown‐heel length and 1,192–4,108 gm in weight. Ten specimens were injected with red‐lead and liquid soap to demonstrate the arteries radiographically. Twelve other specimens were injected with Castolite with a sprinkling of red‐lead and yellow dye. The best side of each specimen was studied by radiography and dissection. This study demonstrated: (1) a masseteric arterial plexus supplying the coronoid process and the lateral wall of the ramus with contributions from the facial, masseter, transverse facial and external carotid arteries or combinations thereof; (2) a mental arterial plexus anastomosing with the mental, submental and inferior labial arteries; (3) an inferior alveolar artery supplying most of the body of the mandible with a majority of its branches passing in an upward direction; and (4) periosteal vessels supplying the lower border of the mandible and receiving their blood supply from the blood vessels supplying the muscles attaching to these areas and the periosteum. Supplemental to the above findings were anastomoses between the submental, mylohyoid and sublingual arteries along the medial border of the mandible. Also a significant variation not previously recorded was noted in one specimen in which the sublingual artery originated from the facial artery rather than the lingual.

Blood supply of human fetal teeth.

AbstractInjection studies were made of the blood vessels of developing human teeth, using 114 unfixed aborted fetuses and new‐born infants ranging in gestation age from three through nine months. These specimens were injected with India ink‐formalin, Micropaque‐formalin, Microfil, or vinyl acetate solutions via the umbilical vessels; in cases where an autopsy had been performed, injection was made through the carotid artery. After further fixation by immersion in 10% neutral formalin, the head was bisected in the sagittal plane. One half was dissected and tissue obtained for microscopic study; the other half was radiographed, dissected or dehydrated and cleared. These techniques revealed that the plexus of vessels which surrounds the developing dental organs is derived mainly from the inferior alveolar and palatine arteries, respectively. However, branches from vessels in adjacent tissues also supplied this plexus. The teeth growing most rapidly, and which usually erupt the earliest, receive the largest blood supply.Odontoblasts were supplied by vessels which course through the dental pulp to their deeper surface. The ameloblasts were adjacent to vessels in the capillary plexus on the outer surface of the enamel organ. A venous sinus was located at the base of the dental organ.

Surgical method for unilateral removal of the inferior dental nerve in the rat.

Surgical method for unilateral removal of the inferior dental nerve in the rat.

Sectioning of the Inferior Dental Nerve in Rats

Sectioning of the Inferior Dental Nerve in Rats

Avulsion of the mandibular body and its reconstruction: Report of a case

This case involved avulsion of the mandibular body with extensive lacerations of the lower third of the face and bilateral fractures of the mandible. The soft tissues of the left cheek, the lower lip, part of the oral floor, and the mandibular body with its teeth formed a complex that was attached only to the right cheek by a cyanotic pedicle 4 cm. wide. The blood supply of the detached complex was poor. The inferior alveolar arteries and veins (and nerves) were avulsed bilaterally and could not be restored. All collaterals from the left cheek and the floor of the mouth, both intraand extraorally, were severed. Only the blood supply from the right check was intact. Repositioning and immobilization of the body of the mandible and plastic closure of all soft tissue wounds was, of course, possible, but there was a question of whether the collateral blood supply would develop fast enough and would be effective enough to prevent massive bone and soft-tissue necrosis. Fortunately, the only necrotic area which developed was in the skin of the mental region; this was followed later by a mild osteomyelitis around the fracture lines, which could be dealt with effectively. The final outcome was functionally and cosmetically satisfactory.

The blood supply of the rat mandible.

AbstractThe blood supply of the rat mandible was studied in 12 adult animals using four techniques. Eight animals were injected with a cinnabar, mercury, zinc oxide mixture (Teichmann's paste) for dissection and for cleared specimens, two with radiopaque material, and two others with India ink. Findings indicate that the coronoid, condylar, and angular processes of the mandible are supplied by vessels which are primarily concerned with the nutrition of the muscles that attach to these areas, and not from the inferior alveolar artery. The inferior alveolar artery supplies the body of the mandible, teeth and adjacent structures. After entering the mandibular foramen this artery bifurcates beneath the third molar tooth. The larger inferior stem passes downward and backward to supply multiple branches to the pulp of incisor tooth and branches to the periodontium about this tooth. The superior stem passes forward beneath the apices of the molar teeth to supply them and the adjacent tissue. The venous drainage of the bone varies – the coronoid and condylar processes drain downward into a confluence of venous channels about the apex of the incisor tooth. Veins of the molar teeth and supporting structures pass through the bone into gingival veins. Concentrations of venous channels primarily draining the angle and condyle are found along the inferior border of the angle and above, where the angular process joins the body proper.

Mandibular prognathism corrected by oblique ostectomy of the ramus: A new, precise, mechanically controlled technique

The importance of the growth of the ramus in normal development of the mandible has been recognized for many years. Sarnat [2] has shown the importance of condylar growth experimentally m monkeys. Ricketts [3] has demonstrated the importance of condylar growth in children using a special radiographic technique. No one has proved that prognathic mandibles develop by any mechanism or in a manner greatly different from that of normal mandibles. The prognathic mandible seems to be an expression of quantitative growth rather than of qualitative growth. The size and shape of the alveolar arches of prognathic patients are usually harmonious after their relationship has been corrected. Therefore, the configuration of the prognathic mandible seems to verify the fact that the overgrowth of bone occurs mainly in the ramus, perhaps greatly influenced by condylar growth, as in normal development. For these reasons we believe an operation in the subcondylar region, as close to the origin of overgrowth as possible, properly performed, will produce the best anatomic and physiologic results. Some of the operations used in the treatment of prognathism, such as those involving the overlapping of bone fragments, produce a second deformity while attempting to correct the original deformity. In the application of our technique we have followed sound orthopedic surgical principles in order to correct the prognathism, while producing a minimal disturbance of the normal anatomic position of the associated structures, thereby maintaining or enhancing proper function and improving esthetics. The submandibular approach, or modification thereof, has proved to be a very popular method of entree into the ramus. With proper precautions the two possible complications which have been mentioned in connection with this approach, i.e., injury to the mandibular branch of the facial nerve and parotid fistula, have not proved to be troublesome in a variety of maxillofacial procedures in which this approach has been used. The ever-present possibility of injury to the internal maxillary artery, and the inferior alveolar artery and nerve which exists in operations on the superior portion of the ramus has been eliminated by the presence of the protecting retractor. (Fig. 6.) At the same time accuracy is assured by the use of a precise cutting guide. By careful preoperative study on a stone articulator, as described herein, the relationship of the holes for interosseous wiring can be determined so as to allow for vertical as well as horizontal transposition of the anterior segment which bears the dental arch, and a balanced occlusion with a positively controlled edge-to-edge approximation of the bone fragments can be assured. We believe this new technique of oblique ostectomy of the ramus offers the following advantages: 1. 1. The operative area, as far as we can determine, is as near the anatomic origin of the deformity as possible. 2. 2. The subauriculomandibular approach offers adequate exposure for good visualization of, and access to, the operative area and leaves an inconspicuous scar. 3. 3. There is no oral contamination of the wounds and an aseptic surgical technique is possible. 4. 4. The special self-retaining retractor offers maximum protection to important blood vessels and nerves medial to the site of ostectomy. 5. 5. The preoperative study and precise cutting guide assures accuracy of ostectomy. 6. 6. At the site of operation the ramus is devoid of important blood vessels and nerves, and is relatively free of muscle attachments. 7. 7. The intact body of the mandible and its contiguous tissues are transposed as a unit. 8. 8. The edge-to-edge approximation of bone fragments, stabilized by interosseous wires, reduces the period of immobilization to a minimum and prevents an open bite deformity. 9. 9. The muscles of mastication, with the exception of the external pterygoid muscles, remain attached to the large, denture-bearing, anterior fragment of the mandible which further tends to stabilize the mandible and prevent an open bite deformity. 10. 10. There is minimal disturbance to or enhancement of the functional positions of the muscles of mastication, muscles of the floor of the mouth and the tongue. 11. 11. No teeth are sacrificed or devitalized, and the size of the alveolar arch is not diminished. 12. 12. The acuteness of the gonial angle is increased. 13. 13. The heads of the condyles are retained in their original positions, thereby maintaining the integrity of the intratemporomandibular joint anatomic relationships. 14. 14. By the removal of accurate sections of bone and interosseous wiring, proper alignment of the fragments is maintained. 15. 15. There is no danger of interposing soft tissue between the bone fragments, and healing of bone in the subcondylar region is excellent. 16. 16. The technique requires no elaborate or special method of intermaxillary fixation during the healing process, and is an excellent procedure for edentulous patients.

On the Sensory Nerve Supply of Dental Pulp, Peridental Membrane, Periosteum, Gum and SERRE's Pearl in the Lower Jaw of Five-Day-Old Kitten

In a 5-day-old kitten, the plexus dentalis originating in the n. alveolaris inferior of the lower jaw was found already very well developed, comprising numerous thick sensory fibres and far less numerous thin vegetative fibres.The rami dentales emerging from this plexus run into the dental pulp of the milk teeth, the number of the nerve fibres increasing abreast with the growth of the teeth. Now, the time these nerve branches enter the dental pulp was found considerably later than was anticipated, for the innervation begins only in the stage where enamel is produced from the enamel organ and dentine from the odontoblasts. Thus, the number of nerve fibres to the dental pulp of the still growing and yet uncut milk tooth is very limited, only a few sensory fibres ending in mere unbranched and simple branched terminations at some distance from the odontoblast layer, no RASCHKOW's plexus being as yet found in formation. No such fibres innervating the odontoblast layer or complex branched terminations in the dental pulp as found in adult animals were found in the mandible of my kitten. The terminal fibres of the existent sensory terminations show little noteworthy change in size or winding in their courses.In my kitten, as found in a 6th month human fetus (SHIRAISHI), besides the milk teeth, immature permanent teeth consisting merely of a cap-shaped dental germ and a dental papilla and somewhat better differentiated permanent teeth were contained in the lower gum. Thick sensory fibres were found entering the rather powerful connective tissue layer covering these buds of permanent teeth and sometimes even the dental germ. These fibres end in unbranched and simple branched terminations with terminal fibres often showing change in size in their courses before ending in sharp points.The peridental membrane between the milk teeth and the alveolar wall is formed in the main of the loose reticular connective tissue forming the dental sac and only in very limited areas by the stout connective tissue as in adult animals. Many nerve fibres from the rami gingivales arising from the plexus dentalis were seen running through this immature peridental membrane toward the propria of the gum while sending out a considerable number of sensory fibres into the membrane in their courses. Their terminations were much simpler than in man and adult dog, simple branched ones forming the majority. Their terminal fibres, however, sometimes show change in size and unusual winding in their courses suggestive of their probable development into very peculiar complex branched terminations as found in adult animals.Some specific sensory terminations were found in the entire area of the young periosteum of the mandible of my kitten, especially, in the alveolar margin. The bone tissue was as yet in the course of growth and the periosteal tissue was still immature, being composed of an outer fibrous connective tissue layer, an osteogenetic layer lining it and an osteoblast layer on the inside. Thick sensory fibres run into this young periosteum accompanying some fine vegetative fibres, and after a repeated ramification end in simple and complex branched terminations. Their terminal fibres often show conspicuous change in size and run into the fibrous layer and further into the osteogenetic layer, even into the osteoblast layer before terminating.In the lower jaw of my newborn cat. I found a small number of SERRE's pearls somewhat smaller in size than those in human fetus. A small number of sensory fibres are found running into these pearls, as in the case with man (SHIRAISHI), forming unbranched or bifurcated terminations therein with terminal fibres showing not much change in size and winding in their courses. The SERRE's organs are presumably so many sensory organs.

Traumatic Aneurysm of the Inferior Dental Artery

Traumatic Aneurysm of the Inferior Dental Artery