Surgical management of the painful lesions of the inferior alveolar nerve

Oral and dental surgery procedure, more often implant placement or inferior third molarextractions, may result in inferior alveolar nerve (IAN) injuries, which are being reported with growing frequency. Nerve damage can also follow orthognathic, pre-prosthetic and salivary gland surgery, or resection of tumors, either benign or malignant. Endodontic treatment and local anaesthetic injections can also result in nerve lesion, which can reduce quality of life by affecting speech, chewing and social interaction.Patients may report either total anaesthesia or hypaesthesia. In case of associated neuropathic pain, prompt treatment is pivotal in order to prevent chronic and irreversible nerve damage. Between 2007 and 2015, 21 patients with pain in the area supplied by the IAN were referred to the Maxillo-Facial Surgery Department of San Paolo Hospital (Milan, Italy). All IAN injuries followed endodontic treatment or oral or maxillofacial surgery. All patients were treated by means of tailored IAN microsurgery. Most of patients affected by pain before surgery experienced complete or partial amelioration of symptoms. In 78.94% of cases, a significant increase in nerve function was observed.According to our data, interpositional nerve grafting represents the optimal method of reconstructing an injured IAN; pain relief and partial recovery of sensation were observed in all patients who underwent this procedure.Scar releasing, nerve decompression and nerve substitution using vein grafts are less effective. Removal of endodontic material extravasated into the mandibular canal or removal or retraction of the implant from the mandibular canal is mandatory and effective in patients experiencing severe pain.