Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roberto Pippi, Andrea Spota, Marcello Santoro
The aim of this review is to improve risk management strategies through analysis of the anatomical, semeiotic and medico-legal aspects that characterize iatrogenic lingual nerve damage (LND) and its legal consequences in case of legal proceedings for a claim for compensation.In dental practice, LND can be caused by local or general anesthesia, or by mechanical, chemical, or thermal mechanisms. A certain post-operative identification of LND etiopathogenesis is often very challenging since it can be difficult to demonstrate at what time and which mechanism actually caused the damage. Clinical tests assessing lingual nerve sensory capabilities have a low sensitivity and moderate specificity, while instrumental tests have the advantage of not being affected by data interpretation subjectivity by both the operator and the patient. The quantification of permanent LND is not uniformly established and there are no specific standard worldwide indications. From a medico-legal point of view, LND is a complication that may or may not be caused by surgical error. The two different concepts of expectability and avoidability or preventability allow to discriminate between professional liability and fate and therefore to determine the surgeon's imputability in LND. Despite clinical competence and practice in performing the medical/surgical procedure, the clinician risks a lawsuit for negligence if he/she does not warn the patient about all relevant risks regardless of their frequency. Informed consent plays an essential role in minimizing litigation; the patient must be informed, taking into consideration both his/her level of culture and ability to understand, of diagnosis, prognosis, therapeutic perspectives and their consequences, in addition to all other viable alternative therapies and the risks of non-treatment as well.
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