INJURIES TO ADJACENT STRUCTURE
During the process of tooth extraction, it is possible to injure adjacent tissues. The prudent surgeon preoperatively evaluates all adjacent anatomic areas and designs a surgical procedure to prevent injury to these tissues.
Prevention of Nerve Injury
1. Be aware of nerve anatomy in surgical area.
2. Avoid making incisions or affecting periosteum in nerve area
the area of the mental nerve and mental for a men must be performed with great care. If the mental nerve is injured, the patient will have an anesthesia or paresthesia of the lip and chin. If the injury is the result of flap reflection or simple manipulation, the altered sensation usually disappears in a few weeks to a few months. If the mental nerve is sectioned at its exit from the mental foramen or torn along its course, it is likely that mental nerve function, will not return, and the patient will have a per.manent state of
anesthesia. If surgery is to be performed in the area of the mental nerve or the mental foramen, it is imperative that surgeons have a keen awareness of the potential morbidity from injury to this nerve (Box 11-6). If surgeons have any question concerning their ability to perform the indicated surgical procedure, they should refer the patient to an oral and maxillofacial surgeon. If a three-corner flap is to be used in the area of the mental nerve, the vertical releasing incision must be placed far enough anterior to avoid severing any portion of the mental nerve: Rarely is it advisable to make the vertical releasing incision at the interdental papilla between the canine and first premolar. The lingual nerve is anatomically located directly against
the lingual aspect of the mandible in the retromolar pad region. The lingual nerve rarely regenerates if it is severely traumatized, Incisions made in the retromolar pad region of the mandible should be placed to avoid severing this nerve. Therefore incisions made for surgical exposure of impacted
third molars or of bony areas in the posterior molar region should be made well to the buccal aspect of the mandible. Prevention of injury to the lingual nerve is of paramount importance far controlling this difficult complication. Finally, the inferior alveolar nerve may be traumatized along the course of its intrabony canal. The most common place of injury is the area of the mandibular. third molar. Removal of impacted third molars may crush or sharply . injure the nerve in its canal. This complication is common enough during the extraction of third molars that it Is important to inform patients on a routine basis that it is a possibility. The surgeon ust then take every precaution
possible to avoid injuring the nerve during the extraction.