Incidence of neurosensory deficits following surgical removal of mandibular third molars: a prospective clinical study

Thaufiq Ahamed M. I., Naveen Jayakumar, Neelakandan R. S.


Background: The aim of this prospective study was to determine the incidences of inferior alveolar nerve and lingual nerve deficit following surgical removal of impacted mandibular third molars and to evaluate the risk factors responsible for these postoperative neurosensory deficits.

Methods: A total of 80 patients who reported to department of oral and maxillofacial surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India requiring surgical removal of impacted mandibular third molar were included in this cross-sectional study. Standard surgical procedure was performed. All patients were reassessed one week post-surgery. Subjectively reported altered sensations were recorded and objective assessments were performed with light touch test, two-point discrimination threshold and pin-pick pain threshold. The collected data was analyzed using the chi square test to find out any clinical relevance.

Results: There was no inferior alveolar nerve related neurosensory deficits and 6 (7.5%) resulted in lingual nerve related neurosensory deficits. The incidence of LN deficit for mesioangular, horizontal, distoangular was 1.3%, 3.8% and 2.5% respectively. Type of impaction assumed a mild statistical significance (p = 0.050).

Conclusions: This study highlights the importance of careful preoperative clinical and radiographic assessment of patients where third molar surgery is planned. The surgical technique of third molar removal is also likely to have great impact on the outcome.


Inferior alveolar nerve, Lingual nerve, Nerve injury, Paraesthesia, Third Molar

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Johansson RS, Trulsson M, Olsson KÅ, Westberg KG. Mechanoreceptor activity from the human face and oral mucosa. Exp Brain Res. 1988;72(1):204-8.

Akal ÜK, Sayan NB, Aydoǧan S, Yaman Z. Evaluation of the neurosensory deficiencies of oral and maxillofacial region following surgery. Int J Oral Maxillofacial Surg. 2000;29(5):331-6.

Bui CH, Seldin EB, Dodson TB. Types frequencies and risk factors for complications after third molar extraction. J Oral Maxillofacial Surg. 2003;61(12):1379-89.

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 Maxillofacial Surg. 2010;39(4):320-6.

Boffano P, Roccia F, Gallesio C. Lingual nerve deficit following mandibular third molar removal: review of the literature and medicolegal considerations. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(3):e10-8.

Alling CC, Helfrick JF, Alling RD. Mandibular third molars. In: Impacted teeth. 1st ed. Philadelphia, PA: WB Saunders; 1993:49-54.

Loescher AR, Smith KG, Robinson PP. Nerve damage and third molar removal. Dent Update. 2003;30(7):375-82.

Tay AB Go WS. Effect of exposed inferior alveolar neurovascular bundle during surgical removal of impacted lower third molars. J Oral Maxillofacial Surg. 2004;62(5):592-600.

Jerjes W, Upile T, Shah P, Nhembe F, Gudka D, Kafas P, et al. Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery-revisited. Oral Pathol Oral Radiol Endodontol. 2010;109(3):335-45.

Kiesselbach JE, Chamberlain JG. Clinical and anatomic observations on the relationship of the lingual nerve to the mandibular third molar region. J Oral Maxillofacial Surg. 1984;42(9):565-7.

Lyons CJ, Bruce RA, Frederickson GC, Small GS. Age of patients and morbidity associated with mandibular third molar surgery. J Am Dental Assoc. 1980;101(2):240-5.

Black CG. Sensory impairment following lower third molar surgery: a prospective study in New Zealand. New Zeal Dental J. 1997;93(413):68-71.

Blondeau F, Daniel NG. Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Canad Dental Assoc. 2007;73(4).

Gülicher D, Gerlach KL. Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofacial Surg. 2001;30(4):306-12.

Kipp DP, Goldstein BH, Weiss WW. Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures. J Am Dental Assoc. 1980;100(2):185-92.

Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: A west of Scotland Oral Surg Res Group study. British J Oral Maxillofacial Surg. 1992;30(2):78-82.

Pogrel MA, Goldman KE. Lingual flap retraction for third molar removal. J Oral Maxillofacial Surg. 2004;62(9):1125-30.

Pichler JW, Beirne OR. Lingual flap retraction and prevention of lingual nerve damage associated with third molar surgery: a systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2001;91(4):395-401.

Leung YY, Cheung LK. Risk factors of neurosensory deficits in lower third molar surgery: a literature review of prospective studies. Int J Oral Maxillofacial Surg. 2011;40(1):1-0.

Blackburn CW, Bramley PA. Lingual nerve damage associated with the removal of lower third molars. British Dental J. 1989;167(3):103.

Ward TG. The split bone technique for removal of lower third molors. Br Dent J. 1956;101:297-304.