Management of third molar-related nerve injuries: observe or treat?

Injury to branches of the trigeminal nerve is one of the possible complications associated with the removal of third molars. Fifty-two percent of patients referred to a university-based practice with trigeminal neurosensory complaints associated their nerve injury with third molar odontectomy. The inferior alveolar nerve (IAN) was the most commonly injured nerve (61.1%), followed by the lingual nerve (LN; 38.8%). There was a 1.5-times greater incidence in females, the mean age of the patients was 34.5 years, and the mean time to consultation from the third molar extraction date was 6.9 months. These data also showed that although the LN was the least commonly injured nerve, it was also the most likely to be severely damaged. It also showed that these patients were most likely to benefit from surgery. On the other hand, the IAN-injured patient often had less severe sensory impairment and therefore would not always benefit from surgical intervention. Therefore, the decision to observe or treat was generally based on which nerve is injured (LN or IAN), and this requires knowledge of the natural course of both LN and IAN recovery following injury, as well as the history of the injury; the physical findings; the results of the diagnostic procedures used to determine the degree of nerve injury; the characteristics of the neuropathic pain, if present; and the potential benefits and risks of surgery, if indicated.