Overview

      Injuries to sensory nerves which supply the feeling in your face, jaws, teeth, gums, lips, or tongue can occur during dental treatment such as root canal fillings or insertion of implants, during surgery on the jaws to remove wisdom teeth, correct jaw deformities, or other procedures. Fractures of the facial bones and soft tissue lacerations may cause significant nerve injuries. Injections of local anesthetics (such as "Novocaine") may also result in nerve injury. Nerve injuries are an inherent risk of any surgical or dental procedure and may occur despite the best of care provided. For example, even amongst the most skilled oral and maxillofacial surgeons, between 1 and 5% of all patients having impacted wisdom teeth removed will experience some degree of numbness or altered sensation of the lips or tongue. This may remain permanently in 0.1 to 1.0% of such patients, if left untreated.

      The patient with a nerve injury may experience a variety of sensations, most of them unpleasant. Numbness, tingling, burning, crawling sensations, electric shocks, or hypersensitivity of the affected area may be the result of a nerve injury. These sensations may interfere with normal chewing, drinking of liquids, speaking, smoking, washing, shaving, or kissing, and they are distressing to the patient. Such symptoms, if persistent beyond one month following surgery, may indicate a nerve injury that will not resolve on its own without surgical intervention or other treatment, and should be evaluated further.

      The development of MICROSURGERY following the introduction of the surgical microscope, magnifying loupes and specialized instruments has made possible the replantation of amputated parts (such as fingers, toes, ears, etc.), surgery on small blood vessels in the brain, and the repair of motor and sensory nerve injuries previously thought to be impossible. Your nerve injury may be able to be repaired by the techniques of MICRONEUROSURGERY. This type of operation is major surgery requiring general anesthesia in the operating room and a short stay in the hospital, often of less than 24 hours, for recovery and postoperative nursing care. Microneurosurgery is technically difficult, and the operation may be several hours in length. The nerve to be repaired and the stitches used are often much smaller than can be visualized with the unaided eye.

Nerve Injuries

Nervre Injuries

      Several types of nerve injury can occur. These include:

• COMPRESSION of the nerve by fragments of bone or tooth, scar tissue or foreign material such as bone fixation screws, wires or plates, or dental implants.
• STRETCHING from manipulation during surgery or traumatic injury.
• Partial or complete SEVERANCE causing interruption or discontinuity of the nerve, or the development of a neuroma (a disorganized mass of nerve tissue which can be quite painful).
• BURNS from caustic substances such as root canal filling materials or medications.

Operations

Operations

      Depending on the type of injury found at surgery, one or more of the following operations can be done:

• DECOMPRESSION, in which the nerve is relieved of any tissue or material pressing upon it.
• NEUROLYSIS, or removal of internal scarring inside the nerve.
• REMOVAL of a neuroma or other abnormal nerve tissue.
• SUTURING, in which the two severed ends of the nerve are brought together and held in place with delicate stitches.
• NERVE GRAFTING, in which a lost portion of nerve is replaced by a graft taken from another sensory nerve in the neck or posterior portion of the lower leg.

Recovery

Recovery

      The outcome of nerve surgery is not totally predictable. However, factors which maximize the chance of partial or complete recovery of normal sensation include:

• The time lapse between the injury and its surgical repair - the sooner the repair is done, the better. The best prognosis occurs when the nerve injuries are repaired within SIX MONTHS. However, later repair might be successful, if the nerve tissue beyond the area of injury has not undergone irreversible degeneration.
• The skill of the surgeon. MICRONEUROSURGERY is a technically demanding skill. Training at specialized courses is a requirement. Nerve operations must be done sufficiently frequently to maintain skills. The oral and maxillofacial surgeons at this clinic possess microneurosurgery skills and perform these operations frequently.

      Your surgeon will discuss with you after completion of your examination, the type of nerve injury you have, the possible operation or other methods of treatment to correct it, and the outlook for improvement of sensation. The costs of surgery and hospitalization are often covered by your medical health care plan. We recommend that all treatment plans be submitted to your insurance carrier for "pre-determination" of benefits.