Inferior Alveolar and Lingual Nerve Repair
Although uncommon, injuries to the inferior alveolar nerve and lingual nerve are a known risk of surgical procedures involving the mandible (lower jaw) and can happen even when standard of care is followed. The inferior alveolar nerve runs in the lower jaw and provides sensation to the teeth, gums, lower lip, and chin on its corresponding side. The lingual nerve branches off the inferior alveolar nerve as it enters the lower jaw and provides sensation and taste to the tongue and floor of mouth on its corresponding side.
Procedures that may lead to injuries of these nerves in descending order of likelihood include; third molar removal (wisdom tooth), other surgical procedures, endodontic therapy, and dental implant therapy. Two types of injuries can occur namely a witnessed injury where your surgeon sees the nerve being injured or an unwitnessed injury where it only becomes obvious days later when there is no return of sensation in the distribution of the nerve. If the nerve injury is witnessed repair at the time of injury or in the postoperative period is often the best choice. If an unwitnessed injury occurs your surgeon will typically treat you with anti-inflammatories and perform serial examinations to determine the likelihood of return of sensation. If there is no return within the first few weeks your surgeon will typically make a referral to a surgeon such as Dr. Nizam who is capable of performing microsurgical nerve repair.
Dr. Nizam will see you at Alabama Surgical Arts for consultation, review the history of your nerve injury, obtain necessary imaging, and examine you to determine if you are a candidate for nerve repair. Ideally nerve repair is performed within 3 months of the injury, however good results have been obtained up to 1 year after injury. Typically, incisions for access are placed inside the mouth. The repair is performed either by reattaching the two ends directly or if necessary using a cadaveric donor nerve to span the gap between the ends of the nerve. If you are a good candidate typical results are 50% return in sensation. In particular, return of protective sensation such as hot/cold/pain/gross sensation which can greatly improve quality of life.
Recovery: Recovery is often minimally painful as the region is partially numb. Swelling is present for 5-7 days. Sutures are resorbable so there is no need for removal. You will be seen at similar intervals for serial examinations to when you had your initial injury; 1 week, 1 month, 2 months, 3 months. Neurosensory exams will be performed over this time period to document return of sensation. A majority of change will be noted in the first 3 months, however return in sensation can continue up to 1 year.
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