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How to Palpate and Release the Mandibular Branch of the Trigeminal Nerve


Introduction

One of the most profound places to get the most of your osteopathic treatment to release the cervical spine, thoracics, and other places is to get changes throughout the trigeminal nerve. The trigeminal nerve (CN V) is a cranial nerve that can influence much of the body. It is important nerve that provides sensory information for much of the head and face, including the sinuses and tongue. The trigeminal nerve also provides sensory information for the dura of the anterior and middle cranial fossa. Finally, the trigeminal nerve also has a motor component innervating the muscles of mastication (masseter, temporalis, and medial and lateral pterygoids).

In this video, I am showing how to release the mandibular division of the trigeminal nerve. This video is part of the An Osteopathic Approach to the Jaw online course. The inferior alveolar nerve, artery, and vein enter the mandibular canal through the mandibular foramen on the medial aspect of the mandibular ramus. They continue through the canal and exit externally at the mental foramen forming the mental nerve branches. Here the mental nerve is easily accessible.

Evaluation

I have observed with thousands of patients that fully releasing and normalizing function of the trigeminal nerve will have a big impact in somatic dysfunction throughout the body. A good way to gauge the status of the trigeminal nerve is through the masseter muscles. Active hypertonicity in the masseter muscle indicates trigeminal nerve upregulation. Palpating the masseter muscle by palpating deeply into the muscle and gliding your fingers back and forth perpendicular to the muscle fibers will show masseter hypertonicity. I also recommend assessing other parts of the body such as the cervical, thoracic, lumbar, and sacral regions bilaterally for motion and tenderness to be able to know the effect of releasing the trigeminal nerve.

A good place to also evaluate specifically is also the mandible itself. Place your hands over the mandible covering as much of the surface area. Gently test for resiliency in the bone by gently moving each side of the mandible medial and lateral gently. By doing this, you can appreciate the pliability and shape of the mandible.

Treatment

This release is for the mandibular branch of the trigeminal nerve. This is not meant to be a complete trigeminal nerve release. I hope to create a course covering this full topic in the near future. With the patient supine, sit behind the patient. Place the ipsilateral hand flat on the side you want to treat covering the rams of the mandible. This will be your palpating hand.

With you other hand, palpate and identify the mental foramen. Once it has been identified, move your finger pads slightly medial to the mental foramen. This will allow you to tug on the nerve and its branches by gliding the skin side to side enough wiggle the nerve and vessels as they exit the mental foramen. As you tug on the nerve, your palpating hand is feeling how the nerve is gliding back and forth through the canal and mental foramen. If there is any restricted motion, move the nerve medial, lateral or in any direction where there is an “ease” felt in the nerve as it moves until a release is felt. Then go recheck by tugging on the nerve again. The motion should feel different through the canal.

Once released through the canal, you can either move your palpating hand or make sure that it is covering the temporal bone in the region of the zygomatic process. Using the same tugging technique, once can then palpate the nerve at the trigeminal ganglion in Meckel’s cave and release it in a similar fashion as described above.

After the mandibular branch has been released, repeat on the other side if needed. Then go back and recheck the mandible, masseter muscles, and any other areas you checked prior to performing the release. More may be necessary to release trigeminal nerve and dura, but this is a concept to practice get better with.

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Daniel Lopez, D.O.

Author Daniel Lopez, D.O.

Daniel Lopez, D.O. grew up with a lot of pain trying many things that did not help. Realizing that if he could not help himself, he would be unable to help others effectively, he dedicated himself to finding real answers. Since that time, Dr. Lopez has found a unique but powerful style where he has patients from around the country and the world that travel to see him for headaches, TMJ issues, eye issues, neck pain, back pain, and more. Daniel Lopez, D.O. is an osteopathic physician with Osteopathic Integrative Medicine. Prior to that he had a private practice in NYC for 6 years. He is the author of the Amazon best seller "Unwinding the Body and Decoding the Messages of Pain: An In-Depth Look into the World of Osteopathic Physicians and How They 'Magically' Use Their Hands for Healing." He lives in Aurora, CO with his wife and daughters.

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