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Unexpected temporary mental nerve deficit after extraction of mandibular first molar: case report

From Volume 38, Issue 4, May 2011 | Pages 261-266

Authors

Paul Amailuk

BDS, FRACDS

Registrar, Department of Oral and Maxillofacial Surgery, Royal Dental Hospital of Melbourne, 720 Swanston St, Carlton, Vic 3053, Australia

Articles by Paul Amailuk

Mark Badcock

BDS, MBBS, FRACDS(OMS)

Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Royal Dental Hospital of Melbourne, 720 Swanston St, Carlton, Vic 3053, Australia

Articles by Mark Badcock

Arun Chandu

BDSc, MBBS(Hons), MDSc, FDSRCS(Eng), FRACDS(OMS)

Consultant Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Royal Dental Hospital of Melbourne, 720 Swanston St, Carlton, Vic 3053, Australia

Articles by Arun Chandu

Abstract

Temporary neurologic deficit affecting the distribution of the left mental nerve was reported in a warfarinized, diabetic patient who had a history of previous CVA with right-sided body weakness. The neurologic deficit was reported following routine extraction of a left mandibular first molar. Recovery of sensation began six weeks after the procedure. Possible mechanisms and preventive measures are discussed.

Clinical Relevance: The reader should understand that mental paraesthesia can be an unexpected outcome in the most routine of mandibular extractions.

Article

Neurologic deficit affecting the mental nerve following a routine extraction of a mandibular first molar is an unexpected outcome. There are several possible causes for isolated mental neuropathy, but the most common by far is as a result of iatrogenic dental treatment.1 This paper documents an occurrence of anaesthesia related to the distribution of the left mental nerve following administration of local anaesthetic for the extraction of the lower left six.

A 40-year-old woman was referred to the Oral and Maxillofacial Surgery Department of the Royal Dental Hospital of Melbourne for the extraction of a carious broken down lower left six. She was initially seen in the emergency department where she complained of having broken a tooth in quadrant 3, which was now irritating her tongue.

Her past medical history included CVA and Type 2 diabetes mellitus. Her medication included warfarin, insulin, omeprazole, artovastatin, spirinolactone and iron and vitamin B tablets. Her extra-oral examination was unremarkable, with no lymphadenopathy noted. She had no history of facial numbness.

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