Lingual access for third molar surgery: a 20-year retrospective audit

We describe a technique for obtaining lingual access for the insertion of a wide metal retractor to protect the lingual nerve from accidental damage during third molar surgery. We also report an audit of a single practice over a 20-year period using the technique described. The approach involves raising soft tissues on the lingual side of the lower third molar tooth to allow insertion of a broad Hovell's lingual retractor. We conclude that raising lingual tissues to form a wide tension-free flap and inserting a specifically designed retractor does not increase the incidence of lingual nerve morbidity. Indeed, the overall incidence of lingual nerve damage was particularly low compared with those in other published series.