Clinical PracticeLingual nerve damage due to inferior alveolar nerve blocks: A possible explanation
Section snippets
MATERIALS AND METHODS
We dissected the lingual and inferior alveolar nerves unilaterally from 12 cadavers. We dissected out the lingual nerve from approximately 5 millimeters above the lingula down to the lower second molar region. The inferior alveolar nerve was dissected out from 5 mm above the lingula to where the nerve entered the inferior alveolar canal just below the lingula. We cut and embedded the specimens 2 mm above the lingula (where a nerve block might be injected) for both the lingual nerve and inferior
RESULTS
The results of the fascicle count at each point are shown in the table (page 197).
For the lingual nerve sectioned just above the lingula, the mean number of fascicles was three (range, one to 8). Four of the 12 nerves (33 percent) were unifascicular at this point. Opposite the third molar, the lingual nerve had a mean of 20 fascicles (range, seven to 39). In every case, there were more fascicles in the third molar region than above the lingula in the same lingual nerve. This must mean that the
DISCUSSION
All studies of nerve damage resulting from inferior alveolar nerve blocks have shown a predominance of lingual nerve involvement over inferior alveolar nerve involvement, and it appears that the lingual nerve may be involved up to 70 percent of the time.2 There seems no obvious reason for this, since if needle trauma or intraneural hematoma were the cause of the problem, one would expect the distribution to be equal. If the cause of the problem was a neurotoxic effect from the local anesthetic
CONCLUSIONS
To date, there has been no explanation of the noted phenomenon that on the rare occasion that an inferior alveolar nerve block causes nerve damage, the lingual nerve is affected 70 percent of the time and the inferior alveolar nerve only 30 percent of the time. Our study demonstrates that there is a difference in the fascicular pattern of these two nerves just above the lingula where an inferior alveolar nerve block is normally deposited. At this site, the lingual nerve is unifascicular in
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2018, Journal of Oral and Maxillofacial SurgeryCitation Excerpt :Pogrel et al14 showed that in approximately 33% of cases, the lingual nerve consisted of a single fascicle at the level of the lingula and 7 to 39 fascicles in the third molar area. The scarce number of fascicles in the proximal segment of the nerve may explain why LND most frequently results in the involvement of the entire lingual nerve distribution territory rather than involvement of a limited number of peripheral areas or involvement of areas with limited extension.14 Furthermore, the distribution of fibers from the chorda tympani in the lingual nerve fascicles has an extremely sectorial localization.
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- 1
Dr. Pogrel is a professor and the chairman, Department of Oral and Maxillofacial Surgery, University of California, San Francisco, Box 0440, 521 Parnassus Ave., San Francisco, Calif. 94143-0440
- 2
Dr. Schmidt is an assistant professor of oral and maxillofacial surgery, Department of Oral and Maxillofacial Surgery, University of California, San Francisco.
- 3
Dr. Sambajon is an assistant professor of clinical oral and maxillofacial surgery, Department of Oral and Maxillofacial Surgery, University of California, San Francisco.
- 4
Dr. Jordan is an associate professor, Division of Oral Pathology, Department of Stomatology, University of California, San Francisco.