Ovidental Editorial Team
hola@ovidentalgo.com
The surgical extraction of mandibular third molars, commonly known as wisdom teeth, is a routine dental procedure.
However, one notable complication associated with this surgery is paresthesia of the inferior alveolar nerve (IAN).
This condition manifests as altered sensations—such as tingling, numbness, or a loss of feeling—in areas innervated by the IAN, including the lower lip, chin, and gums on the affected side.
Causes of Inferior Alveolar Nerve Paresthesia
Paresthesia can arise from various factors during or after the extraction of a mandibular third molar:
* Anatomical Proximity
The close relationship between the roots of the third molar and the mandibular canal housing the IAN can heighten the risk of nerve injury during surgery.
* Surgical Technique
Inadequate surgical maneuvers, such as excessive force during tooth elevation or improper sectioning of the tooth, can lead to nerve trauma.
* Postoperative Inflammation
Swelling or hematoma formation following surgery can compress the nerve, resulting in sensory disturbances.
Prevention and Management of Paresthesia
To minimize the risk of paresthesia and effectively manage this complication, the following strategies are recommended:
1. Comprehensive Preoperative Evaluation
Conduct thorough radiographic assessments, such as panoramic radiographs or cone-beam computed tomography (CBCT) scans, to determine the relationship between the third molar and the mandibular canal.
Radiographic indicators like darkening of the tooth root where it crosses the canal, deviation of the canal, narrowing of the roots, loss of the lamina dura of the canal, or a juxta-apical area can signal a higher risk of nerve injury.
2. Meticulous Surgical Technique
Employ precise and minimally invasive surgical methods tailored to the patient's specific anatomy to reduce the likelihood of nerve damage.
3. Patient Information
It's crucial to inform patients about potential risks and complications of the procedure, including paresthesia, to set realistic expectations and facilitate informed decision-making.
4. Alternative Surgical Approaches
In cases where the third molar is in close proximity to the IAN, a coronectomy—removal of the tooth's crown while leaving the roots intact—may be considered to decrease the risk of nerve injury.
5. Postoperative Management
If paresthesia occurs, initial treatment may involve observation, as many nerve injuries are temporary and resolve within weeks to months.
In some cases, medications such as anti-inflammatories or vitamin B complexes are prescribed to support nerve healing.
6. Continuous Monitoring
Regular follow-up appointments are essential to assess the progression of sensory recovery.
If paresthesia persists beyond six months, referral to a specialist in nerve repair or microsurgery may be warranted for further evaluation and potential intervention.
► Recommended Reading: ALVEOLITIS: The most common complication in oral surgery
Conclusion
Preventing paresthesia of the inferior alveolar nerve following mandibular third molar extraction is paramount.
Adequate preoperative planning, careful surgical execution, and diligent postoperative care are vital to minimize risks and ensure optimal patient recovery.
