Anatomy & Histology · patient case question
Which nerve is most at risk when this tooth is surgically removed through a palatal approach?
Patient case: Eight-year-old with an unerupted central incisor
Patient: Male, 8 years old, accompanied by his mother
Chief complaint: Mother: “His front tooth still hasn't come in and the other one came in a year ago.”
History: Healthy. No trauma history. No medications.
Findings: Mixed dentition. Tooth #9 is erupted; #8 is unerupted with adequate space. A periapical of the anterior maxilla is of poor quality, but an inverted conical tooth is visible in the midline above the incisor roots. A triangular radiopacity appears in the corner of the film.
Show answer and explanation
Correct answer: C. Nasopalatine nerve
- A. The greater palatine nerve emerges at the greater palatine foramen adjacent to the second or third molar and supplies the posterior hard palate. It is nowhere near the midline anterior region.
- B. The infraorbital nerve exits the infraorbital foramen below the orbital rim to supply the lower eyelid, lateral nose and upper lip. It is well superior to the surgical field.
- C. CORRECT. The nasopalatine nerve descends through the incisive canal and emerges at the incisive foramen just behind the central incisors, supplying the anterior palatal mucosa back to the canines. A midline supernumerary sits directly in its path, so palatal flap reflection and bone removal put it at risk. Transient numbness of the anterior palate is a recognised sequela; the territory is small and reinnervation is usually good.
- D. The anterior superior alveolar nerve, a branch of the infraorbital nerve, supplies the anterior teeth and their labial periodontium via a labial approach — relevant to a labial flap, not the palatal one described.
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