Neuropathic Pain Due to Iatrogenic Lingual Nerve Lesion: Nerve Grafting to Reduce Otherwise Untreatable Pain.

Iatrogenic lingual nerve lesion is a well-known and unfortunate complication after mandibular third molar removal. Occasionally, the nerve injury can cause severe neuropathic pain. Here, the authors present the history of 2 patients with lingual nerve injury due to mandibular third molar removal, and with severe neuropathic pain in the craniomandibular region. Pharmacotherapy and physiotherapy did not reduce the pain, and ultimately, the lingual nerve was surgically explored. Scar tissue and a lingual nerve neuroma were observed and resected in both patients. In the first patient, the gap between the nerve stumps was bridged with an autologous sural nerve graft. In the second patient, some continuity of the lingual nerve was preserved and the resected part was substituted with an autologous sural nerve graft. Significant pain reduction was achieved in both patients and no further medical treatment was necessary at the end of follow-up. These reports show that lingual nerve reconstruction can be a successful therapy in patients experiencing severe neuropathic pain after iatrogenic lingual nerve injury. Different treatment options for neuropathic pain due to lingual nerve injury are discussed. (C) 2016 by Mutaz B. Habal, MD.

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