Introduction : Le système nerveux autonome (SNA) est en situation supralévatorienne, le système somatique en situation infra lévatorienne. Le sympathique assurerait les fonctions de sécrétion et le parasympahtique, les fonctions dʼérection. Le rectum est en rapport étroit avec ces éléments nerveux. La protectomie avec exérèse totale du mésorectum pour cancer est associée à des séquelles sexuelles par lésion iatrogène des nerfs pelviens.Objectifs : Étudier la physiologie et lʼanatomie topographique et structurelle de l'innervation pelvipérinéale Matériels et méthodes : Cinq pelvis de foetus et dix pelvis dʼadultes féminins ont été prélevés pour études macroscopiques, microscopiques etimmunohistochimiques des nerfs pelviens. Les coupes ont été colorées puis immunomarquées pour détecter les fibres nerveuses (PS-100), somatiques(PMP22), autonomes adrénergiques (TH), cholinergiques (VAChT), sensitives(CGRP) et les fibres pro-érectiles (nNOS). Les lames ont été numérisées et reconstruites en 3D.Résultats : Les fibres nerveuses du SNA, richement interconnectées,véhiculent de façon mixte lʼinflux sympathique et parasympathique.Celles issues du plexus hypogastrique inférieur contrôlant les fonctions sexuelles sont regroupées avec le pédicule vaginal long et forment la bandelette neuro-vasculaire (BNV) sur la face antérolatérale du rectum à « 2et 10h ». Cette BNV est en avant de lʼexpansion postérolatérale du septum recto vaginal (SRV) qui la protège et qui est lʼéquivalent chez lʼhomme du fascia de Denonvilliers. Cette BNV concentre lʼensemble des fibres nerveusespro-érectiles destinées au périnée. Une lésion tronculaire de cette bandelette pourrait conduire à un trouble de lʼérection clitoridienne et de la lubrification vulvaire car, à ce niveau, les efférences sympathiques et parasympathiques coexistent.Conclusion: Un modèle anatomo-physiologique et pédagogiquedʼinnervation pelvipérinéale féminine a été développé. Ces travaux offrent des perspectives dʼétudes cliniques afin de mieux évaluer les dysfonctions sexuelles postopératoires. / Introduction: The nerve supply of the autonomic nervous system (ANS) to the pelvis is located above the levator ani muscle, and the somatic nerve supply to the pelvis is situated below levator ani. Sympathetic innervation assures secretory functions and parasympathetic innervation allows erection. The rectum is anatomically closely associated with these nerves. Protectomy with total excision of the mesorectum for cancer is associated with sexual sequellae due to iatrogenic damage to the pelvic nerves.Objectives: To study the physiology and topographic and structural anatomy of the innervation of the pelvis.Materials and methods: Five fœtal pelvises and ten adult female pelvises were collected for macroscopic, microscopic, and immunohistochemical studies of pelvic nerves. Sections were stained and then immunostained to reveal nerve fibres (PS-100), somatic nerves (PMP22), adrenergic autonomic nerves (TH), cholinergic autonomic nerves (VAChT), sensory nerves (CGRP) and pro-erectile nerves (nNOS). Sections were numbered and reconstructed in 3D.Results: ANS nerve fibres, densely interconnected, carry a combination of sympathetic and parasympathetic fibres.Nerve fibres controlling sexual function from the inferior hypogastric plexus are clustered along the vaginal pedicle and form the neurovascular bundle (NVB) on the anterolateral face of the rectum between “2 and 10 o’clock”. This NVB is in front of the expansion of the rectovaginal septum (RVS) which protects it. In males, the equivalent structure is the rectoprostratic fascia. This NVB contains all of the pro-erectile nerves supplying the perineum. A truncal lesion to this bundle could result in erectile dysfunction of the clitoris as well as difficulties in vulvar lubrication because sympathetic and parasympathetic efferent fibres are both present at this site.Conclusion: An educational anatomical and physiological model of the innervation of the female pelvis and perineum has been developed. This work offers perspectives for clinical studies to facilitate better evaluation of cases of post-operative sexual dysfunction.

O nervo alveolar inferior (Nai), o mais espesso ramo do nervo mandibular (V par craniano), está funcionalmente relacionado à inervação da mandíbula e dentes inferiores, além de parte dos tecidos moles circunjacentes. Seu estudo morfológico, sobretudo em mandíbulas adultas, foi sistematicamente realizado, contudo, sem ainda haver um consenso definitivo para o seu padrão de ramificação. Desse modo, considerando-se a importância em se demonstrar um modelo de constituição básica para o Nai, realizou-se o presente estudo em fetos humanos da 19ª a 36ª semana de vida intrauterina. Foram utilizados 86 hemimandíbulas, de ambos os sexos, em que se avaliou o padrão morfológico intraósseo do Nai e de seus ramos, seus envoltórios conjuntivos e suas relações com as estruturas vasculares, utilizando-se de microdissecção e microscopia eletrônica de varredura (MEV). Relativamente ao padrão morfológico do segmento intramandibular do Nai, foram propostos 4 tipos de ramificação: Tipo I (16%), onde o Nai emite 3 ramos principais, os nervos alveolares inferiores posterior (Naip), médio (Naim) e anterior (Naia); Tipo II (34%), semelhante ao anterior, porém ausente o Naim; Tipo III (30%), semelhante ao primeiro, porém ausentes Naim e o Naia; e o Tipo IV (20%), a forma clássica do Nai, onde somente o Naia se ramifica a partir dele. Verificou-se uma série de conexões entre todos os feixes nervosos, sobretudo entre o Naip e o Nai, sendo que os ramos dentais e peridentais partem, em sua maioria, do Naip, Naim e Naia. Sobre os envoltórios conjuntivos, verificou-se que se espessam à medida que o feto se desenvolve, notando também a presença de uma bainha neurovascular comum a envolver o feixe vasculonervoso alveolar inferior. Quanto ao posicionamento da artéria alveolar inferior, adjacente ao forame da mandíbula, cruza o feixe nervoso, em sua maioria, pela face medial (41%) ou pela lateral (55%), para logo em seguida alcançar sua posição definitiva sobre a face superior do feixe nervoso. Quanto às veias alveolares inferiores, em número de 1 a 3, posicionam-se posteromedialmente às outras estruturas do feixe vasculonervoso. Para a veia de Serres, observada em todos os espécimes e envolta por um canal ósseo, propôs-se a terminologia veia paramandibular. / The inferior alveolar nerve (Nai), the thickest branch of the mandibular nerve (V pair of cranial nerve), is functionally related to jaw and lower teeth innervation as well as, being part of the surrounding smooth tissue. The Nai morphology has been systematically studied in mandible of adults however, no definitive consensus has been reached in relation to its branched pattern. Therefore, this study was been performed in 19 to 36 week-gestation fetuses, due to the importance of determining a basic model of Nai as available data refers only to its arrangement in adults. Micro dissection and Scanner Electron Microscopy (MEV) were performed on 86 human hemi-mandibles of both sexes in order to evaluate the morphological intraosseous pattern of Nai and its branches, its connective tissue and their relationship with vascular structures. In connection with the morphological pattern of intramandibular segment of Nai, four types of branches were proposed: Type I (16%) where Nai give rise to 3 main branches: posterior inferior alveolar nerve (Naip), medium (Naim), and anterior (Naia); Type II (34%), similar to Type I but Naim was absent; Type III (30%), similar to the first, however Naim and Naia were absent; and type IV (20%),the classic form of Nai, from which only Naia was raised. A series of connections was verified among all of the nervous bundles, especially between Nai and Naip. besides dental and periodontal branches commonly arising from Naip, Naim and Naia. In relation with the connective tissues, it was shown that they became thicker as the fetuses are developing; at this stage it was also noted one neurovascular sheath covering nerve bundles and blood vessels. Relatively to the inferior alveolar artery position, adjacent to mandible foramen, it can, frequently, cross the nerve bundle through medial (41%) or lateral surface (55%), reached after its final position on the superior surface of nerve bundle; the inferior alveolar veins (1 to 3), are posterior-medially positioned to the neurovascular bundle other structures. The terminology paramandibular vein was proposed to the Serres vein observed in all specimens studied which was surrounded by bone channel.

O nervo alveolar inferior (Nai), o mais espesso ramo do nervo mandibular (V par craniano), está funcionalmente relacionado à inervação da mandíbula e dentes inferiores, além de parte dos tecidos moles circunjacentes. Seu estudo morfológico, sobretudo em mandíbulas adultas, foi sistematicamente realizado, contudo, sem ainda haver um consenso definitivo para o seu padrão de ramificação. Desse modo, considerando-se a importância em se demonstrar um modelo de constituição básica para o Nai, realizou-se o presente estudo em fetos humanos da 19ª a 36ª semana de vida intrauterina. Foram utilizados 86 hemimandíbulas, de ambos os sexos, em que se avaliou o padrão morfológico intraósseo do Nai e de seus ramos, seus envoltórios conjuntivos e suas relações com as estruturas vasculares, utilizando-se de microdissecção e microscopia eletrônica de varredura (MEV). Relativamente ao padrão morfológico do segmento intramandibular do Nai, foram propostos 4 tipos de ramificação: Tipo I (16%), onde o Nai emite 3 ramos principais, os nervos alveolares inferiores posterior (Naip), médio (Naim) e anterior (Naia); Tipo II (34%), semelhante ao anterior, porém ausente o Naim; Tipo III (30%), semelhante ao primeiro, porém ausentes Naim e o Naia; e o Tipo IV (20%), a forma clássica do Nai, onde somente o Naia se ramifica a partir dele. Verificou-se uma série de conexões entre todos os feixes nervosos, sobretudo entre o Naip e o Nai, sendo que os ramos dentais e peridentais partem, em sua maioria, do Naip, Naim e Naia. Sobre os envoltórios conjuntivos, verificou-se que se espessam à medida que o feto se desenvolve, notando também a presença de uma bainha neurovascular comum a envolver o feixe vasculonervoso alveolar inferior. Quanto ao posicionamento da artéria alveolar inferior, adjacente ao forame da mandíbula, cruza o feixe nervoso, em sua maioria, pela face medial (41%) ou pela lateral (55%), para logo em seguida alcançar sua posição definitiva sobre a face superior do feixe nervoso. Quanto às veias alveolares inferiores, em número de 1 a 3, posicionam-se posteromedialmente às outras estruturas do feixe vasculonervoso. Para a veia de Serres, observada em todos os espécimes e envolta por um canal ósseo, propôs-se a terminologia veia paramandibular. / The inferior alveolar nerve (Nai), the thickest branch of the mandibular nerve (V pair of cranial nerve), is functionally related to jaw and lower teeth innervation as well as, being part of the surrounding smooth tissue. The Nai morphology has been systematically studied in mandible of adults however, no definitive consensus has been reached in relation to its branched pattern. Therefore, this study was been performed in 19 to 36 week-gestation fetuses, due to the importance of determining a basic model of Nai as available data refers only to its arrangement in adults. Micro dissection and Scanner Electron Microscopy (MEV) were performed on 86 human hemi-mandibles of both sexes in order to evaluate the morphological intraosseous pattern of Nai and its branches, its connective tissue and their relationship with vascular structures. In connection with the morphological pattern of intramandibular segment of Nai, four types of branches were proposed: Type I (16%) where Nai give rise to 3 main branches: posterior inferior alveolar nerve (Naip), medium (Naim), and anterior (Naia); Type II (34%), similar to Type I but Naim was absent; Type III (30%), similar to the first, however Naim and Naia were absent; and type IV (20%),the classic form of Nai, from which only Naia was raised. A series of connections was verified among all of the nervous bundles, especially between Nai and Naip. besides dental and periodontal branches commonly arising from Naip, Naim and Naia. In relation with the connective tissues, it was shown that they became thicker as the fetuses are developing; at this stage it was also noted one neurovascular sheath covering nerve bundles and blood vessels. Relatively to the inferior alveolar artery position, adjacent to mandible foramen, it can, frequently, cross the nerve bundle through medial (41%) or lateral surface (55%), reached after its final position on the superior surface of nerve bundle; the inferior alveolar veins (1 to 3), are posterior-medially positioned to the neurovascular bundle other structures. The terminology paramandibular vein was proposed to the Serres vein observed in all specimens studied which was surrounded by bone channel.