Expert Witness Journal Dec 24 - Journal - Page 49
Mrs Winterbotham thought that the risk to the LN
did not apply to her as the defendant had not pointed
it out to her.
The defendant was criticised for his lack of record
keeping and failure to gain informed consent.
It was put forward in defence that a coronectomy
would have :
• reduced risk to both nerves
• removed the source of the pericoronitis
The claimant had altered speech and sensation and
won substantial damages.
Summary
In my experience when a M3M is within 2mm of the
IAN canal then I always suggest a coronectomy.
A coronectomy rarely involves a CT scan and healing
is much quicker.
I still raise a buccal flap but once I have access, cutting
the crown in a horizontal fashion is quite easy to do.
Even a distoangular molar can be elevated buccally
without the need for distal bone removal.
More surgeons should offer a coronectomy approach
when there is a risk to the Lingual nerve and or the
Inferior Alveolar nerve.
Disadvantages :
• if roots are loosened, they may migrate upwards
(Renton)
• if the nerve pulp is left behind and become necrotic,
it may become infected
• a second surgical procedure may be required at a
much later date
Patients should be aware that coronectomy is not
without complications, but the risk to the nerves is
minimal when done with experienced hands.
References
Association of Oral and Maxillofacial surgeons of India
Diagnosis, pathophysiology, management and future issues
of trigeminal surgical nerve injuries
T. Renton et al
Oral Surgery 13 (2020) 389--403.
Legal issues Winterbotham versus Sharak (N Moody
KC)
This case was heard on 16-19 July 2024 and involved
Lingual nerve damage to Mrs Winterbotham during
the elevation of a disto-angular impacted LR8 by Mr
Sharak, a specialist oral surgeon.
The effects of NICE guidelines on the management of
third molar teeth.
McArdle L, Renton T Br Dent J 2012; 213: E8–E8.
Change in clinical status of third molars in adults during 12
years of observation.
Ventä I, Turtola L, Ylipaavalniemi P.
J Oral Maxillofac
Surg 1999; 57: 386–9.
It was argued that the risks of LN injury were not
explained to the claimant.
The claimant was not offered a coronectomy
procedure.
International Statistical Classification of Diseases and
Related Health Problems.
World Health Organization.
10th Revision. Volume 2.
Geneva: WHO; 2011
Mr Sharak did not undertake coronectomies.
The defendant argued that even if the risks had been
explained that the claimant would still have gone
ahead with the procedure.
A prospective study of clinical outcomes related to third
molar removal or retention.
Huang GJ et al.
Am J Public Health 2014; 104: 728–34.
The claimant was a speech and language therapist and
claimed that her employment had been taken from
her because of the injury.
Treatment of mandibular third molars and pericoronitis
in British military personnel: influence of guidelines from
the National Institute for Health and Clinical Excellence.
Pepper T, Konarzewski T, Grimshaw P, Combes J.
Br J Oral Maxillofac Surg. 2016 Dec;54(10):11111115.
Neil Moody KC presiding over the case started his
introduction with a summary of the basic anatomy
around M3Ms.
He correctly identified the LN and the IAN as being
at risk of damage.
Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 years of clinical experience
Caissie R, Goulet J, Fortin M, Morielli D..
J Can Dent
Assoc (Tor) 2005;71:185–90.
He included the defendants risk sheet, warning
of damage to the surrounding nerves, but Mrs
Winterbotham denied ever seeing the sheet.
EXPERT WITNESS JOURNAL
A randomised controlled clinical trial to compare the in47
DECEMBER 2024
