Nerve injuries and repair

Trigeminal nerve injuries may occur from third molar surgery, local anaesthetic injections, orthognathic surgery, maxillofacial trauma, implant surgery or pathology surgery, and most often involve the inferior alveolar nerve, the lingual nerve and the infraorbital nerve. Nerve repair is indicated where the nerve injury is significant (Sunderland IV or V degree injury), demonstrated either by direct visual inspection or by clinical neurosensory testing or adjunctive testing (i.e. magnetic resonance neurography, trigeminal nerve conduction, chemosensory testing, etc.). Repair should be carried out at the earliest opportunity under microscopic magnification by a trained microsurgeon. (Although no standard exists for training in microneurosurgery of the trigeminal nerve, suggested standards for training in microsurgery exist and include a minimum 40+ hours of didactic courses and laboratory experience including the successful anastomoses of ten arteries, ten veins and ten neural repairs. A trained microneurosurgeon should serve as first assistant to an experienced microneurosurgeon in at least three cases and then serve as primary surgeon in six cases.) • Witnessed nerve injury from third molar surgery, orthognathic surgery (e.g. sagittal split osteotomy), implant surgery or mandibular or maxillary trauma.