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Lingual nerve neuropathy: more than just third molar surgery and inferior alveolar nerve blocks Wei Cheong Ngeow Wen Lin Chai Dental Update 2024 46:8, 707-709.
Authors
Wei CheongNgeow
Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universiti Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia
Neuropathy of the lingual nerve, when it occurs, often results from third molar surgery, or the provision of inferior alveolar nerve blocks. Investigators have reported that the anatomical location and the unpredictable course of the lingual nerve play important roles in it being affected by these procedures. However, there are many other causes of neuropathy with which most medical and dental practitioners are unfamiliar. This article briefly reviews the course of the lingual nerve, and summarizes the causes and reports of all uncommon aetiologies of neuropathy that can occur along the path of a lingual nerve. The clinical implication and management of lingual nerve neuropathy is discussed.
CPD/Clinical Relevance: The reader should appreciate the importance of accurately diagnosing lingual nerve neuropathy as it can manifest from many other dental procedures and non-dental causes, apart from routine mandibular third molar surgery and local anaesthetic injections.
Article
Peripheral nerve neuropathy is a condition where damage to a particular branch of the peripheral nerve results in weakness, numbness and/or pain in the area of innervation. A recent article has extensively reviewed neuropathy affecting the mandibular branch of the trigeminal nerve, mainly in association with ‘numb chin syndrome’.1 Based on this review, a summary of the causes of neuropathy is provided in Table 1. Neuropathy involving the lingual nerve, either alone or with other branches of the trigeminal nerve, is not commonly reported, but merits special attention. Most are iatrogenic in origin, and involve third molar surgery, dental local anaesthetic injections, intubation, ablative surgery and submandibular gland surgery. Of these, third molar surgery has been reported as the most common cause of lingual nerve injuries.2 Often, numbness is the chief complaint if the lingual nerve is injured. However, Peñarrocha et al reported that nerve injuries can be painful and this symptom affected up to 57% of their patients.3 This painful neuropathy was more often observed in older patients with neurosensory deficit.3 In contrast, younger patients reportedly had less pain and recovered faster from this symptom.3 Investigators have reported that the anatomical location and the unpredictable course of the lingual nerve is an important factor contributing to iatrogenic injury, besides the skill of the surgeons.
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