CAN MICROSURGICAL REPAIR OF INFERIOR ALVEOLAR NERVE INJURIES IMPROVE SENSORY FUNCTION AND RELIEF OF PAIN?  

The nerve bundle that runs through the mandible provides sensory perception (feeling) to the lower lip and chin, the teeth and gums, and there is a branch that goes to the side of the tongue. The nerve enters the bone on the inside surface at the back of the jaw and then runs forward from there through the bone and branches to those areas. The roots of the teeth, especially the roots of the third molar teeth (wisdom teeth) in the adult often approximate or overlap the nerve bundle putting it at risk in various types of dental treatments such as extractions and root canal therapy. (J Oral Maxillofac Surg 79:1434-1446, 2021). Fortunately, this is a rare occurrence with specialists, but it can occur and I have had it happen. Nerve injury, and the need for repair, is much more common after trauma such as jaw fractures.

When it does occur, the typical problem is decreased sensory (partial or complete loss of feeling in a spot, region, or area). In rare instances, there can be pain along with this which is more likely to prompt us to consider attempting a procedure to decompress or repair the nerve. This type of microsurgical repair is so rare, that there really are no “specialists” to perform this – but our training in this and our experience with the structures and anatomy, along with similarity to other procedures, makes this a treatment that a board certified OMFS with experience in orthognathics and fracture treatment should be able to provide. If you are near a regional center where advanced training may exist, a referral may be made.

These are low-yield procedures and so frankly it is not a desirable surgical treatment to provide. “Low-yield” means that the results are rarely excellent. The cited article indicates that the procedure to effect a repair or decompression of the nerve resulted in some improvement in pain sensation, but little improvement in the return of feeling.

In the few patients that I have treated, surgical findings were typically not significant – that means that we usually did not see a significant injury or bone problem. When we did, and when corrected – we saw great improvement in symptoms. This may seem obvious, but there are also cases where you do not see issues surgically, but the patients show improvement after the procedure. I do feel that our bodies have a significant ability to heal themselves. Sometimes it is useful to help that along through decompression.