Trigeminal Foundation

Nerve Injuries

Helping to prevent, educate and manage

Prevention and management

Minimising and managing nerve injuries in dental surgical procedures
by Tara Renton

The most significant complications from dental surgical interventions are iatrogenic trigeminal nerve injuries, which can result in permanent altered sensation and pain, causing considerable functional and psychological disability. This paper provides some useful tips on

minimising the risks of these injuries. By understanding the risk factors and modifying the resulting intervention, more of these injuries may be prevented.

The removal of mandibular third molars (M3Ms) is a common surgical procedure and – as with all surgical procedures – there is a risk of opera- tive and postoperative complications. Overall, the rate of complications is reported to be 3.47%, though these vary in severity. Known risk factors for poor surgical outcomes in rela- tion to M3M surgery are: surgical dif- ficulty, older age, poor oral hygiene and smoking.

Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. The incidence of lingual nerve injury has remained static in the UK over the last 30 years; however, the incidence of inferior alveolar nerve injury has increased, probably due to increase or advances in implant surgery and endodontic therapy. The risk factors associated with nerve injury in rela- tion to third molar surgery include age and ethnicity of patient, length of surgery (difficulty), operator (ju- nior) and, most importantly, lingual access.