Lingual and inferior alveolar nerve injuries after third molar removal

Trigeminal nerve injury is a rare, but serious complication of a common procedure, which results in a clinically relevant problem that deserves attention. The emergence of microsurgical repair of trigeminal injury has provided clinicians with treatment options for patients who experience persistent neurosensory deficits. The area of microsurgical repair of trigeminal nerves is now in its adolescence. While great strides have been made in the field since its conception, it is certain that a new generation of oral and maxillofacial surgeons wil bring further progress to the field. In the future, better quantitative sensory testing methods, more accurate imaging modalities, and advances in surgical technique will certainly improve the management of patients with impacted third molars. As clinicians, every day we are confronted with the management of impacted third molars. It is important to evaluate each patient individually with an appropriate clinical and radiographic exam. Every patient should be informed of the relative risks and benefits of third molar removal and a joint decision should be reached between the clinician and patient regarding ideal treatment. However, even with ideal management, complications will occur. If a patient does present with signs of a nerve injury the clinician should carefully document the neurosensory deficit and monitor the patient over time. If the patient exhibits a significant sensory deficit for more than one month a referral for evaluation to a tertiary care center capable of surgical repair of the injury is recommended. The occurrence of a "trigger" or Tinel's like sign is improtant as an indication for surgery but may not occur for a month after injury.