Incidence of Injuries in Inferior Alveolar Nerve After Surgical Removal of Mandibular Third Molar. Prospective Study

Abstract

Background and objective: Inferior dental alveolar nerve injury is a recognized complication of mandibular third molar surgery, potentially resulting in sensory disturbances such as paresthesia and numbness in the lower lip and chin. Our study is aimed of to evaluate the incidence of IAN injury following surgical removal of third molar and to assess its management and outcomes.

Material and Method; Our study was involved surgical extraction of lower wisdom tooth for hundred patients. Preoperative assessments radiographically & clinically were accomplished. Around six months postoperative follow up period for any changes in neurosensory feeling for patients, with recording duration and management of I. A. N. injury.

  Results; Factors of endanger represented in near proximity and deep impaction that making the roots in or around the mandibular canal, were resulted in permanent harm or damage persist after six months in four percent ((4%)) among the total number of 100 patients involved in the study. Transient effect or symptom of postoperative nerve harm/injury was clear in eight percent ((8%)) of patients among 100 case, were the symptom was solved and disappear within 3 months.

Conclusion; Surgery of the lower wisdom tooth stay accompanied with nerve harm or injury of inferior alveolar nerve. Effects could be temporary ((transient)) or permanent deficit which involve small ratio among patients. The essential keys for decreasing the incidence of nerve deficit/injury beside enhancing sequelae, were achieved by focusing on early/premature intervention, preoperative radiograph, and congruent surgical procedure.

Keywords:

Inferior alveolar nerve injury, third molar surgery, Mandibular nerve, Paresthesia, Risk factors.

References

- Kwon G, Hohman MH. Inferior Alveolar Nerve and Lingual Nerve Injury. 2023 Mar 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 369439

- Tay AB, Lai JB, Lye KW, Wong WY, Nadkarni NV, Li W, Bautista D. Inferior Alveolar Nerve Injury in Trauma-Induced Mandible Fractures. J Oral Maxillofac Surg. 2015 Jul;73(7):1328-40. doi: 10.1016/j.joms.2015.02.003. Epub 2015 Mar 7. PMID: 25914133.

- Kämmerer PW, Heimes D, Hartmann A, Kesting M, Khoury F, Schiegnitz E, Thiem DGE, Wiltfang J, Al-Nawas B, Kämmerer W. Clinical insights into traumatic injury of the inferior alveolar and lingual nerves: a comprehensive approach from diagnosis to therapeutic interventions. Clin Oral Investig. 2024 Mar 15;28(4):216. doi: 10.1007/s00784-024-05615-4. PMID: 38488908; PMCID: PMC10942925.

- Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Oct;92(4):377-83. doi: 10.1067/moe.2001.118284. PMID: 11598570.

- Kang F, Sah MK, Fei G. Determining the risk relationship associated with inferior alveolar nerve injury following removal of mandibular third molar teeth: A systematic review. J Stomatol Oral Maxillofac Surg. 2020 Feb;121(1):63-69. doi: 10.1016/j.jormas.2019.06.010. Epub 2019 Aug 30. PMID: 31476533.

- Sarikov R, Juodzbalys G. Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. J Oral Maxillofac Res. 2014 Dec 29;5(4):e1. doi: 10.5037/jomr.2014.5401. PMID: 25635208; PMCID: PMC4306319.

- Queral-Godoy E, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Mar;99(3):259-64. doi: 10.1016/j.tripleo.2004.06.001. PMID: 15716829.

- Boffano P, Roccia F, Gallesio C, Karagozoglu K, Forouzanfar T. Inferior alveolar nerve injuries associated with mandibular fractures at risk: a two-center retrospective study. Craniomaxillofac Trauma Reconstr. 2014 Dec;7(4):280-3. doi: 10.1055/s-0034-1375169. Epub 2014 Jun 5. PMID: 25383147; PMCID: PMC4221141.

- Yadav S, Sachdeva A, Shekhawat H, Vinay. Time-Lapse Between Presentation and Treatment of Mandibular Fractures: Is There a Correlation With Sensory Loss Recovery or No Recovery? J Craniofac Surg. 2021 Jun 1;32(4):e369-e373. doi: 10.1097/SCS.0000000000007261. PMID: 33235168.

- Murayama M, Sasaki K, Shibahara T. Electrophysiological evaluation of nerve function in inferior alveolar nerve injury: relationship between nerve action potentials and histomorphometric observations. Int J Oral Maxillofac Surg. 2015 Dec;44(12):1529-39. doi: 10.1016/j.ijom.2015.09.004. Epub 2015 Oct 1. PMID: 26433750.

- Kang SK, Almansoori AA, Chae YS, Kim B, Kim SM, Lee JH. Factors Affecting Functional Sensory Recovery After Inferior Alveolar Nerve Repair Using the Nerve Sliding Technique. J Oral Maxillofac Surg. 2021 Aug;79(8):1794-1800. doi: 10.1016/j.joms.2021.02.036. Epub 2021 Mar 1. PMID: 33781730.

- Agbulut N. Assessing nerve injuries in oral surgery: a survey-based study on prevention and management. Med Oral Patol Oral Cir Bucal. 2025 May 1;30(3):e462-e468. doi: 10.4317/medoral.26995. PMID: 40121682; PMCID: PMC12019647.

- Agbaje JO, Heijsters G, Salem AS, Van Slycke S, Schepers S, Politis C, Vrielinck L. Coronectomy of Deeply Impacted Lower Third Molar: Incidence of Outcomes and Complications after One Year Follow-Up. J Oral Maxillofac Res 2015;6(2):e1 doi: 10.5037/jomr.2015.6201

- Naruse T, Suyama K, Fukushima H, Nakamura N, Yamashita K, Furukawa K, Morishita K, Rokutanda S, Yamada T. Recovery from inferior alveolar neurosensory changes after lower third molar extraction: A multicenter, retrospective study. Medicine (Baltimore). 2025 Jan 3;104(1):e41227. doi: 10.1097/MD.0000000000041227. PMID: 40184092; PMCID: PMC11709186.

- Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH. Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases. Int J Oral Maxillofac Surg. 2010 Apr;39(4):320-6. doi: 10.1016/j.ijom.2009.11.010. Epub 2010 Jan 12. PMID: 20061121.

- Li Y, Ling Z, Zhang H, Xie H, Zhang P, Jiang H, Fu Y. Association of the Inferior Alveolar Nerve Position and Nerve Injury: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2022 Sep 16;10(9):1782. doi: 10.3390/healthcare10091782. PMID: 36141394; PMCID: PMC9498832.

- Bhat P, Cariappa KM. Inferior alveolar nerve deficits and recovery following surgical removal of impacted mandibular third molars. J Maxillofac Oral Surg. 2012 Sep;11(3):304-8. doi: 10.1007/s12663-012-0335-0. Epub 2012 Feb 19. PMID: 23997481; PMCID: PMC3428439.

- Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res. 2013 Jul 1;4(2):e1. doi: 10.5037/jomr.2013.4201. PMID: 24422029; PMCID: PMC3886113.

- Myers, D. A multivariate statistical analysis on variables affecting inferior alveolar nerve damage during third molar surgery. Br Dent J 219, 168–169 (2015). https://doi.org/10.1038/sj.bdj.2015.662

- Ramadorai A, Tay ABG, Vasanthakumar G, Lye WK. Nerve Injury After Surgical Excision of Mandibular Third Molars Under Local Anesthesia: An Audit. J Maxillofac Oral Surg. 2019 Jun;18(2):307-313. doi: 10.1007/s12663-018-1151-y. Epub 2018 Sep 19. PMID: 30996556; PMCID: PMC6441419.

- Balaji SM, Balaji PP. Textbook of Oral and Maxillofacial Surgery. 4th ed. Amsterdam: Elsevier; 2022.

- Pippi R, De Luca S, Pietrantoni A. A Prospective Observational Study on the Variables Affecting the Risk of Inferior Alveolar Nerve Damage During Lower Third Molar Surgery with Nerve/Root Proximity. J Oral Maxillofac Surg. 2022 Jan;80(1):13-21. doi: 10.1016/j.joms.2021.08.162. Epub 2021 Aug 30. PMID: 34582807.

- Nguyen E, Grubor D, Chandu A. Risk factors for permanent injury of inferior alveolar and lingual nerves during third molar surgery. J Oral Maxillofac Surg. 2014 Dec;72(12):2394-401. doi: 10.1016/j.joms.2014.06.451. Epub 2014 Jul 3. PMID: 25236821.