Expert Witness Journal Dec 24 - Journal - Page 47
Patients at risk of postoperative infection can include:
• smokers
• patients with poor oral hygiene
• diabetics
• patients on immunosuppressants
• patients on bisphosphonate drugs
Posterior Division
Auriculotemporal - sensory nerve to skin and area
around the TMJ and ear.
Lingual nerve (LN) - sensory nerve runs in the
mucosa below and behind the M3M
and the tongue side mucosa
• supplying the anterior 2/3rds of the tongue
• floor of the mouth
• lingual mucosa and gingivae
• submandibular and sublingual glands
• carries the Chorda Tympani nerve carrying taste
sensation to the anterior 2/3rds of the tongue
There is little evidence that patients who are
prescribed antibiotics after surgery have a reduced risk
of complications (Renton).
The more serious risk is damage to the mandibular
nerve branches during surgery.
Nerve damage could result in :
• Paraesthesia (the sensation of tingling, burning,
pricking or prickling, skin-crawling, itching, “pins and
needles” or numbness on or just underneath your
skin)
• Anaesthesia
• Dysesthesia (unusual touch based symptoms)
• Hyperesthesia
• Ageusia (loss of taste)
• Dysgeusia (altered taste)
Inferior Alveolar nerve enters the mandible body at
the ramus and sits within the inferior alveolar canal
along with the Inferior Alveolar artery (IAA)
Nerve injury may be temporary and may subside after
6 months, however if longer the injury was considered
permanent (Iwanaga)
It is good practice that patients are warned of these
risks if they apply; see later.
Mandibular nerve anatomy
Association of Oral and Maxillofacial Surgeons of India
Motor - Mylohyoid and Anterior belly of the Digastric
muscle.
Sensory –
• sensation to all the teeth
• sensation to the skin and mucosa of the lower lip
The IAC and M3M
The radiographic presentation on a panoral
radiograph can show the IAN canal superimposing
over the roots, and in most cases the canal is visible on
radiographs
The Trigeminal nerve constitutes the largest sensory
cortex representation in the brain compared with
other sensory nerves, this is because the Trigeminal
nerve provides sensory innovation to sight, smell,
taste, hearing and speech.
Damage to the branches of the Trigeminal nerve
during molar surgery can cause significant psychological morbidity (Caissie)
The Trigeminal nerve (V) branches into the
Ophthalmic, Maxillary and Mandibular nerves.
The Mandibular nerve is the only branch that contains motor fibres and innervates:
Anterior Division
Motor Innervation - Muscles of mastication
Sensory innervation - Buccal nerve (buccal mucosa)
EXPERT WITNESS JOURNAL
45
DECEMBER 2024
