Diagnosis and treatment methods in inferior alveolar and lingual nerve injuries: A review

Abstract

Injuries to the inferior alveolar nerve (IAN) and lingual nerve (LN) are common complications of oral and maxillofacial surgery, frequently occurring during third molar extractions, implant placements, and orthognathic procedures. These injuries can lead to sensory deficits and negatively affect the patients’ quality of life. Although some cases resolve spontaneously, early diagnosis and appropriate treatment, including microsurgical repair, are often necessary to optimize the outcomes. This review aims to summarize the current approaches for the diagnosis and treatment of IAN and LN injuries and highlight emerging techniques in nerve regeneration. A comprehensive literature review was conducted to evaluate the classification of nerve injuries (Seddon and Sunderland), diagnostic modalities such as nerve stimulation tests and magnetic resonance neurography, timing of surgical intervention, and available treatment options, including neurorrhaphy, autografts, allografts, nerve conduits, pharmacologic therapies, and adjunctive regenerative strategies. Mild nerve injuries may recover spontaneously within 3–9 months; if sensory function does not return within this period, surgical repair is generally indicated. Early surgical intervention (within 3–6 months) yields more favorable outcomes, although later repair can still be beneficial. Direct neurorrhaphy is recommended for small nerve gaps (≤5 mm), whereas larger defects require grafting. Autografts, such as the sural or great auricular nerves, are the gold standard because of their compatibility; however, they entail donor-site morbidity. Processed allografts and conduits offer viable alternatives with reduced surgical time, although they can be costly and less predictable. Adjunctive therapies, including platelet-rich fibrin, corticosteroids, and low-level laser therapy, have demonstrated potential benefits but require further clinical validation. New biomaterials that incorporate stem cells and growth factors show promise for enhancing nerve regeneration. Effective management of IAN and LN injuries requires timely diagnosis and an individualized treatment plan based on the injury severity and patient factors. Early surgical repair improves the likelihood of functional recovery. While autografts remain the preferred method for reconstructing large nerve gaps, processed allografts and nerve conduits are valuable alternatives. Ongoing advances in regenerative materials and adjunctive therapies hold potential to improve outcomes and reduce complications associated with peripheral nerve repair.