Lingual Nerve Injury

Steven B. Graff-Radford, DDS, Randolph W. Evans, MD


Headache. 2003;43(9) 

In This Article


The incidence of lingual nerve injury consequent to surgery depends upon the procedure being performed, the surgeon's experience, procedure methodology, and certain patient-specific factors.[22,23,24,25,26] Following mandibular third molar removal, the incidence of permanent nerve damage is reported to vary between 0.5% and 2%.[21,24,25,26] In a US survey of oral and maxillofacial surgeons, 76% reported having had cases complicated by lingual nerve anesthesia, dysesthesia, or paresthesia. In 18.6% of cases, the sensory symptoms failed to resolve, and only 3 cases underwent surgical nerve repair.

Permanent injury to the nerve following nerve block is rare, occurring in 1:175 000 procedures.[3] In the non-English literature, the incidence is cited as between 1:67 000 and 1:200 000.[22] In a retrospective study, Haas reported the incidence as 1:785 000 injections. Krafft reported an incidence of 0.15% of lingual sensory disturbance associated with local anesthetic administration. The incidence of permanent injury was 0.008%.

The location of impacted teeth and a person's age also contribute to the incidence of injury. Wisdom teeth that are lingually oriented, or those where there is direct contact with the inferior alveolar canal, are more likely to be associated with injury. It has been reported that if the teeth are partially erupted, the risk of lingual nerve paresthesia is increased.[22] There is a greater incidence of injury as persons become older; those over aged 35 years are at greatest risk. Injury seems to adversely affect females more often than males. Surgical duration is another variable that may contribute.[22]

Incidence of lingual nerve injury following mandibular third molar removal may depend on the surgical technique. Raising and retracting a lingual mucoperiosteal flap with a Howarth periosteal elevator may result in more frequent injury, but this is temporary. Rood reported an initial incidence of 6.6%[18,26]; Blackburn and Bramley, 11%[24]; and VonArx and Simpson, 22%.[27] The majority recover over a few days or a few months, but symptoms remain in 0.5%[24] to 0.6% of patients.[25] Using a lingual flap and Obwegeser periosteal elevator also may increase the incidence, especially when distal site ostectomy is performed.[22]