Alveolar Nerve Injured During Molar Extraction

Case Overview
Client underwent a wisdom tooth extraction and suffered injury to the right Inferior Alveolar Nerve eventually resulting in a right sagittal split osteotomy of the mandible. Injury is permanent.

Issue
1. Is this a known risk?

2. Could the injury have been avoided?

3. Is this a type of injury that occurs in the absence of negligence?

4. Could any type of nerve anomaly contributed to the injury?

5. Should he have referred him out as soon as he knew about the injury?

medQuest Expert Responses:

Injury to the inferior alveolar nerve is a known risk of third molar surgery and it is the standard of care to discuss this injury as part of the informed consent process. Protocol for managing nerve injuries are immediate referral if known nerve transection has occurred or close observation for spontaneous return of sensation with referral at 2-3 months if no improvement. The injury itself is not indicative of a deviation from the standard of care. Not clear what the sagittal split was done for- even in transection cases, anastomosis of nerve is usually done by decortication of canal from cheek side. Without seeing radiographs of impaction and proximity to nerve canal and records to determine indication for removal, it is not possible to determine if treatment was appropriate.
DR LS – Oral Surgeon

 

This is a known risk of the procedure that should be disclosed during the informed consent process. It can happen despite the best of surgical care, or could be due to poor or negligent care. The timing of referral for micro neurosurgical evaluation is based on multiple factors including specifics/findings of the surgical procedure, early post-extraction presentation, early/ongoing sensory status/recovery, etc. Can’t really provide any specific answers without reviewing all of the data.
Dr DB – Oral Surgeon