Management Of Lingual Nerve Injury

By : Mohammed N. Omer

4th stage

Lingual nerve:The lingual nerve is a branch of the mandibular division of the trigeminal nerve supplying the anterior two thirds of the tongue and responding to stimuli of pressure, touch, and temperature

Nerve injury

1) Neuropraxia : refers to local myelin injury with the axon still intact and functional. considered a temporary paralysis of the nerve fiber, least severe injury

Recovery: hours to months (avg 6-8 weeks)

2) Axonotmesis : the axon and myelin is disrupted here, but the neuronal connective tissue remains intact (endo-, peri-, epineurium), more severe.

3) Neurotmesis : most severe form

not only the axon, but also injury to the myelin , axon , as well as one of the following:

a) Endoneurium

b) Perineurium

c) Epineurium, the most severe case

Recovery: incomplete; imperfect.

Causes Of Lingual nerve injury

1. The vast majority of lingual nerve injuries occur during the extraction of a mandibular third molar .

2. less commonly the lingual nerve can be injured by local anesthetic dental injections.

3. sublingual or submandibular surgery.

Symptoms:

1. Pain: most common symptom

2. Discomfort: discomfort when eating, chewing, talking and in performing other routine tongue functions.

3. Burning sensation. This symptom might be experienced a few days after the tooth extraction procedure.

4. Numbness tingling feeling.

5. Tugging or pulling sensation.

Treatment

1. Surgical – a variety of procedures.

2. Laser treatment – low‐level laser treatment has been used to treat partial loss of sensation.

3. Medical – treatment with drugs including B12and painkillers.

4. Counselling – including relaxation therapy, hypnosis.

Surgical Intervention

1. Neurorrhaphy

1. Epineural

2. Perineural

3. Epi-perineural

2. Nerve grafting

Removal of lower 3rd molar

Division of lingual n. noted

Immediate microsurgical repair or urgent referral

Post operative review

Stimulus-evoked (paresthesia) Anesthesia (surgical intervention

maybe required)

MONITER RECOVERY

3 months after injury

Some recovery No evidence of recovery Consider referral to a specialist

Continue to monitorLimited further

recovery

Factors that influence regeneration after neurorrhaphy

1. Age of patient

2. Gap between nerve ends

3. Delay between time of injury and repair

4. Level of injury

5. Experience & technique of surgeon

https://www.researchgate.net/publication/8094868_Complications_associated_with_surgical_management_of_Ranulas

http://ispub.com/IJHNS/1/1/8975

Thank You