DIAGNOSTIC AND THERAPEUTIC MANAGEMENT OF IATROGENIC LESIONS OF LINGUAL AND INFERIOR ALVEOLAR NERVE

Trigeminal nerve branches injuries are more and more frequent because of the wide spread of oral surgery. When the nerve damage involves the lingual nerve (LN) or the inferior alveolar nerve (IAN), the negative impact of the nervous dysfunction on the daily life of patients is relevant. Patients usually describe their condition as a crippling disease interfering with their common daily activities (talking, eating and drinking) and, consequently, forcing them to give up their social life. This difficult situation is undoubtedly worse when pain is present. It is about a neuropathic pain due to the nerve damage and the wrong regeneration process that make a mixture of nervous fibres and scar tissue. It is a dull pain described by one of our patient as “a monster that never gives up, always present as a new life-mate”. Moreover, all these feelings and patients’ adaptability have always to be correlate to the kind of surgery that caused the symptoms themselves. It’s not easy to understand and accept a complete lingual anaesthesia associated with continuous pain appeared after the removal of an asymptomatic wisdom molar! The same symptoms appeared after the removal of a malign tumour are usually more acceptable. Unfortunately, even today, there is no worldwide consensus about how to early recognize and eventually treat this kind of lesions. Nowadays, these iatrogenic nerve damages culminate more and more frequent in legal matters. A standardization of diagnostic and therapeutic management is necessary, to clarify which the correct approach for each patient is. This project aimed to standardize through the founding of a specific Clinic the management of patients affected by lingual nerve and inferior alveolar nerve lesion, in order to propose a common diagnostic process, followed by both the patient-specific reconstructive surgery and the regular clinic and neurophysiological follow up. The standardized management allows to understand the actual efficacy of this kind of surgery.