Objective Assessment of Lingual Nerve Microsurgical Reconstruction

Lingual nerve (LN) injury is one of the most serious consequences of oral surgery. Prompt microsurgical reconstruction of the nerve can alleviate most of those symptoms leading to satisfactory functional recovery. Thirty-five patients with partial to complete LN injury underwent surgery in the period between January 2006 and May 2015. All patients underwent a preoperative clinical and neurological evaluation with the assessment of lingual tactile and pain sensory thresholds and masseteric inhibitory reflex. All patients underwent explorative surgery and direct microneurorrhaphy of distal and proximal stumps in case of complete lesion, while the removal of traumatic neuroma and the following microneurorrhaphy of distal and proximal stumps of the injured nerve was performed in case of incomplete lesion. Nerve grafting has always been avoided because of distal stump mobilization obtained by severing the submandibular branch of the LN. All patients but 1 exhibited good recovery of tongue sensation, never complete, both clinically and electrophysiologically: recovery of the excitability of masseteric inhibitory reflex suppression components SP1 and SP2 was observed, often with increased latencies but consistent with a functional recovery. All patients feeling pain preoperatively experienced complete relief of algic symptoms. The early microsurgical approach is the most suitable choice for the treatment of LN injuries. Lingual nerve injuries (LNI) are a potential clinical consequence in oral and maxillofacial surgery, leading to significant functional impairments (anaesthesia, hypoesthesia, dysesthesia, hyperesthesia, pain).1–5 Burning dysesthesia accompanies anaesthesia in almost 40% of patients. In 8% to 15% of patients, pain remains the most debilitating sequela, requiring adequate treatment.6,7 Patients experience the LNI-related functional impairment as a real psychological and physical discomfort.8 Knowledge gaps in the management of LNI patients lead to dissatisfaction with the service received and worsen the acceptance of neural deficits. Our work aims to objectively assess lingual nerve (LN) deficits and results of related microsurgery. Based on those data, we propose a guideline for LNI management, emphasizing the importance of timely diagnosis and surgical intervention. Follow-up should concentrate on preventing chronic sensory deficits to maintain patients’ quality of life.9