Prevention of lingual nerve injury in third molar surgery: literature review

Publication date: Available online 4 January 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roberto Pippi, Andrea Spota, Marcello Santoro
PurposeTo identify any factors which may aid the surgeon in preventing or minimizing the risk of lingual nerve injury during third molar surgery.MethodsElectronic research was carried out on the correlation between lingual nerve damage and lower third molar surgery (topographic anatomy, surgical technique, and regional anesthesia) using PubMed, Scopus and Cochrane central databases. The research only included articles published in English up to February 2016.ResultsLingual nerve anatomy varied greatly: direct contact between the lingual nerve and the third molar alveolar wall was reported in a wide range of cases (0-62%) and the nerve was located at the same level or above the top of the ridge in 0-17.6% of cases. No detailed data was found on the actual incidence of lingual nerve injury resulting from local anesthesia by injection. Permanent lingual nerve damage did not show statistically significant differences between the simple buccal approach and the buccal approach + lingual flap retraction, although the latter was significantly associated with an increased risk of temporary damage. As far as permanent damage was concerned, no statistically significant differences were found between the lingual split technique and the buccal approach with or without lingual flap retraction. As opposed to tooth sectioning, ostectomy was strongly statistically associated with permanent lingual nerve damage.ConclusionsResults should be interpreted with extreme caution due to the considerable heterogeneity of the data as well as the considerable influence of several anatomical and surgical variables, all closely related, but which are difficult to analyze independently. It seems preferable to avoid lingual flap elevation, except in selected cases in which the presence of more than one unfavourable surgical variable predict a high risk of nerve injury. Tooth sectioning may reduce the extent of ostectomy or even, in some cases, prevent it, potentially acting as a protective factor in lingual nerve injury.



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