Nerve Injury Treatment

Nerve injuries are uncommon in dental practice, but for the patient who sustains an injury to a nerve in the head and neck region, the rarity does not matter. If you believe you may have had a nerve injury, FACES Fort Worth is here to help!

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Branches of the trigeminal cranial nerve are the primary sensory (feeling) nerve in the face. The most commonly injured sensory nerves are the inferior alveolar nerve (supplies sensation to the lower lip, chin, and lower teeth) and the lingual nerve (supplies general sensation, not taste, to the bulk of the tongue). Less commonly injured branches of the trigeminal include the infraorbital nerve (supplies sensation to the mid-face, side of the nose, and upper lip) and the long buccal nerve (supplies the inner cheek tissue near the back of the mouth. 

Injuries to these nerves can occur during various procedures, including tooth removal, dental implants, corrective jaw surgery, facial trauma, treatment of cysts or tumors, root canal therapy, and local anesthetic injections. In many instances, nerve injuries can be challenging to avoid, no matter how unfortunate it is to have occurred. Often anatomic variations within the facial structures put the nerve at significant risk, notably regarding wisdom tooth removal and dental implants.

It is important to have a surgeon who can provide appropriate evaluation, counseling, surgical treatment, and non-surgical treatment/rehabilitation. Most nerve injuries resolve completely within several days to weeks, but nerves are notoriously slow to recover. Occasionally it takes many months to recover, and sometimes the injury results in permanent sensory changes. Neurosensory testing (NST) is a set of non-invasive tests meant to objectively measure the level of dysfunction. NST can be done periodically to monitor for improvement or lack thereof.

In the case that improvement is seen without any surgical intervention, there are some rehabilitation exercises that may be performed to aid in neurosensory recovery. In some cases, the injury is so severe that little-to-no recovery occurs or the improvement plateaus, at which point your surgeon may recommend a surgical procedure in an attempt to improve your quality of life.

The decision of whether surgery is appropriate is a decision to be made with your surgeon if the situation is appropriate. The procedure itself is not a major surgery, but oftentimes it needs to be done in a hospital setting under general anesthesia, but it usually takes less than two hours. The procedures are generally well tolerated.

Incisions are almost always placed inside the mouth, but occasionally the surgeon may need to make an incision in a neck crease in order to properly access it. Once the nerve is located, the condition of the nerve is evaluated for any structural abnormalities. A number of factors play into the method of repair, which are specific to the situation, but several options exist to repair the nerve. Sometimes all that is needed is “decompression,” where any physical factors that may be causing the abnormal sensation are relieved. If part of the nerve is so injured that it needs to be removed, a gap between healthy nerve segments is created. These gaps can be reconstructed by several means, including direct reconnection of the nerves using very small sutures. If direct reconnection is not possible, it will be reconstructed using a nerve graft, which is a cadaveric nerve specimen processed to remove any traces of the specimen from which it was harvested.

There are many factors contributing to the success of a nerve repair. The severity of injury may play a role. However, the most commonly referenced factors include the age of the patient and the amount of time elapsed since injury. Typically, nerve recovery is better in a younger patient. However, adequate recovery can occur in older patients as well. Surgical intervention is also more successful as soon as it is necessary. The rule of thumb is that as soon as a diagnosis is made where a procedure is indicated, it should be done. Patients do experience recovery following repair when a greater time has elapsed; however, the likelihood does decrease.  When the conditions are right, the success rate for recovery has been reported to be 80-90% of the time. Another major factor is the experience and comfort of your surgeon performing the repair.

As mentioned, experience plays an important factor in the success of your nerve repair. In the United States, there are only a handful of surgeons who perform a significant number of nerve cases. Dr. Sonneveld had the opportunity to spend an entire year training side by side with Drs. Roger Meyer and Shahrokh Bagheri, two surgeons nationally renowned for their experience in treating nerve injuries and publishing research from the inception of treating trigeminal nerve injuries and continuing today. Working with them, he gained exceptional experience in evaluation, rehabilitation, surgical repair, and post-operative care. With the help of Drs. Meyer and Bagheri, Dr. Sonneveld prepared several manuscripts for publication in peer-reviewed scholarly journals.

Give us a call today at 817-927-1818 or fill out the form below to schedule an appointment. You’ll be happy you chose Facial & Cosmetic Surgery Fort Worth.