Clinical insights into traumatic injury of the inferior alveolar and lingual nerves: a comprehensive approach from diagnosis to therapeutic interventions

Abstract

Objectives: This scoping review explores the risk and management of traumatic injuries to the inferior alveolar and lingual nerves during mandibular dental procedures. Emphasizing the significance of diagnostic tools, the review amalgamates existing knowledge to offer a comprehensive overview.

Materials and methods: A literature search across PubMed, Embase, and Cochrane Library informed the analysis.

Results: Traumatic injuries often lead to hypo-/anesthesia and neuropathic pain, impacting individuals psychologically and socially. Diagnosis involves thorough anamnesis, clinical-neurological evaluations, and radiographic imaging. Severity varies, allowing for conservative or surgical interventions. Immediate action is recommended for reversible causes, while surgical therapies like decompression, readaptation, or reconstruction yield favorable outcomes. Conservative management, utilizing topical anesthesia, capsaicin, and systemic medications (tricyclic antidepressants, antipsychotics, and serotonin-norepinephrine-reuptake-inhibitors), proves effective for neuropathic pain.

Conclusions: Traumatic nerve injuries, though common in dental surgery, often go unrecorded. Despite lacking a definitive diagnostic gold standard, a meticulous examination of the injury and subsequent impairments is crucial.

Clinical relevance: Tailoring treatment to each case's characteristics is essential, recognizing the absence of a universal solution. This approach aims to optimize outcomes, restore functionality, and improve the quality of life for affected individuals.

Keywords: Anesthesia; Hypoesthesia; Life quality; Medication; Nerve injury; Neuropathic pain; Review; Trauma.

Fig. 1

Panoramic radiograph depicting a patient presenting with numbness of the right lip and chin. The removal of the lower wisdom tooth on the corresponding side occurred one year ago. The radiograph clearly displays the lower border of the nerve canal of the inferior alveolar nerve, with a somewhat blurred upper border. Notably, a tooth-shaped dense region is evident, overlapping the nerve canal, raising concerns about a potential injury to the inferior alveolar nerve

Fig. 2

Magnetic resonance imaging of the right lower jaw from the patient depicted in Fig. 1, shown in a sagittal section. The nerve, presented as a light-shaded hyperintense structure, is clearly discernible within the darker, hypointense bone structure. The arrow highlights a conspicuous interruption in the structure of the inferior alveolar nerve precisely at the location of the prior wisdom tooth osteotomy. This observation significantly aids in the diagnosis of nerve damage

Fig. 3

Section of a panoramic radiograph illustrating a dental implant in the region of tooth 47, demonstrating its close proximity to the inferior alveolar nerve. The placement of the implant resulted in a mild hyposthesia experienced by the patient in the chin region

Fig. 4

Panoramic radiograph of a patient where root filling material was accidentally overfilled into the nerve canal in the mesial root of tooth 47. This resulted in recurrent neuropathic pain, which disappeared after the removal of the material

Fig. 5

Clinical image depicting the surgical decompression of the right inferior alveolar nerve, which sustained damage during wisdom tooth osteotomy

Fig. 6

Clinical site presentation following impaction of teeth 48 with iatrogenic rupture of the lingual nerve. In Fig. 6a, the lingual nerve's iatrogenic rupture is visually indicated by a distinguished blue arrow. Moving forward, Fig. 6b showcases the repair of the affected nerve through a direct anastomosis procedure employing 8–0 sutures

Fig. 7

Sural nerve removal. The sural nerve typically offers cutaneous innervation to the skin of the posterior to posterolateral leg and can be harvested at the ankle level with minimal postoperative morbidity