Early Diagnosis of Iatrogenic Post-Traumatic Trigeminal Neuropathies: From Clinical Gaps to Medico-Legal...

Background: Iatrogenic injuries of the inferior alveolar nerve (IAN) and lingual nerve (LN) are among the most relevant complications in oral surgery. Although most cases show spontaneous recovery, a significant proportion of patients develop persistent post-traumatic trigeminal neuropathies (PTNs). The aim of this narrative review is to critically analyze current diagnostic approaches for IAN and LN injuries, highlighting the limitations of conventional assessment tools and evaluating the potential role of emerging neurophysiological and imaging techniques in improving early diagnosis, prognostic stratification and medico-legal management. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus and Web of Science for English-language studies published up to 23 March 2026. Evidence on trigeminal nerve injuries, neurosensory assessment, quantitative sensory testing (QST), advanced imaging techniques and medico-legal implications was qualitatively synthesized. Results: The prognosis of iatrogenic PTNs of both IAN and LN is influenced by the severity of nerve injury and the timing of diagnosis and management. Although conventional neurosensory testing (NST) is widely used in the clinical assessment of trigeminal nerve injuries, its ability to objectively characterize the extent and severity of nerve damage is limited. Complementary neurophysiological and quantitative sensory approaches may provide additional functional information, while magnetic resonance neurography (MRN) offers direct structural assessment of the injured nerve. Early objective identification of nerve injury may support prognostic evaluation and timely clinical decision-making. Conclusions: An integrated approach combining clinical assessment, neurophysiology and advanced imaging is essential for early characterization of iatrogenic trigeminal nerve injuries. MRN may provide structural information, contributing to early stratification of injury severity. Quantitative sensory and neurophysiological techniques may complement conventional clinical testing. These diagnostic advances may also have important medico-legal implications, as delayed diagnosis may lead to loss of therapeutic opportunity and increased professional liability.