Diagnosis, follow-up and treatment of lingual nerve lesions

ABSTRACT

II The lingual nerve (NL) can be injured during surgical procedures performed on the retromolar trigone and the medial aspect of the mandibular ramus, particularly during extraction surgery of impacted third molar teeth (NL injury occurs in 0.6-2% of cases). Lesions due to truncal infiltration are generally milder and resolve spontaneously.

Clinical: In most cases, it involves anesthesia/hypoesthesia of the hemitongue, posterior floor of the mouth, and ipsilateral lingual attached gingiva. Paresthesias are present in half of the cases. Approximately 15% of patients suffer from pain.

Diagnosis: The initial diagnosis is based on symptoms. If symptoms do not resolve within 3 months, instrumental trigeminal sensitivity testing allows for a definitive diagnosis of NL functional deficit. Morphological methods such as anatomical MRI and tractography with 3 Tesla machines are currently being studied.

Treatment: Nerve regeneration supplements such as alpha-lipoic acid and L-acetylcarnitine are administered during the first few days. If the anesthesia persists, a diagnosis of nerve transection is made three months after the injury, indicating reconstructive microsurgery (self-resolving NL strains/crushes, on the other hand, show early clinical signs of functional recovery). NL reconstruction can be performed even several years after the injury, although recovery rates are less guaranteed. In cases of pain, urgent microsurgery is indicated, which can be performed even years after the nerve injury. Chronic cases or cases where microsurgery is not indicated can be treated with pain therapy.

Clinical cases: videos and photographs of clinical cases and microsurgical interventions are shown.

Discussion: Ample time is given to discussion and answers to participants’ questions.

The webinar will present the diagnostic/therapeutic algorithms summarizing the “good clinical practice recommendations” developed by a multidisciplinary group of experts coordinated by Professor Biglioli on behalf of the Italian Society of Maxillofacial Surgery.