Lingual Nerve Injury

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

Disclosures

Headache. 2003;43(9) 

In This Article

Predisposing Factors

Nerve Location

Close proximity of the lingual nerve to the cortex of the mandible may cause entrapment.[5] A number of studies agree there is great variability in lingual and inferior alveolar nerve position. Carter and Keen indicate that although the inferior alveolar nerve is considered to be localized to the bony canal, in as many as 40% of cases there are large branches outside the canal subjecting them to possible injury.[28] Variability in the lingual nerve anatomy associated with location of the third molar provides for higher risk of injury. The nerve may lie above the lingual plate or even on the alveolar crest.[4,29,30] The number of cases varies from 8.8% to 17.6% in results from anatomical dissections, and 15% in a magnetic resonance imaging (MRI) study.[29,30] It is emphasized in these studies that the clinician can not use only the lingual plate as a reference to ensure lingual nerve protection, as often the nerve is in the soft tissue above the bone. It may lie in contact with the lingual plate in 57.4% to 62% of cases as seen in anatomical dissections,[4,29] and in 25% of cases evaluated by MRI.[30]

Nerve Location

Close proximity of the lingual nerve to the cortex of the mandible may cause entrapment.[5] A number of studies agree there is great variability in lingual and inferior alveolar nerve position. Carter and Keen indicate that although the inferior alveolar nerve is considered to be localized to the bony canal, in as many as 40% of cases there are large branches outside the canal subjecting them to possible injury.[28] Variability in the lingual nerve anatomy associated with location of the third molar provides for higher risk of injury. The nerve may lie above the lingual plate or even on the alveolar crest.[4,29,30] The number of cases varies from 8.8% to 17.6% in results from anatomical dissections, and 15% in a magnetic resonance imaging (MRI) study.[29,30] It is emphasized in these studies that the clinician can not use only the lingual plate as a reference to ensure lingual nerve protection, as often the nerve is in the soft tissue above the bone. It may lie in contact with the lingual plate in 57.4% to 62% of cases as seen in anatomical dissections,[4,29] and in 25% of cases evaluated by MRI.[30]

Genetics

Although there is still no direct evidence of a genetic predisposition for nerve injury, the recovery and resultant pain may have a genetic base.

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