Håndtering af nerveskader efter kirurgisk fjernelse af mandiblens tredjemolar

Injuries to oral branches of the trigeminal nerve after dental treatments are generally rare but occurs most frequently in relation to surgical removal of the mandibular third molar and can be highly debilitating for the patient. The literature reports a number of anatomical and surgical risk factors for damage of the inferior alveolar nerve, lingual nerve, and buccal nerve, which the dentist must be aware of and consider in the surgical planning. When a neurosensory disturbance occurs, it is crucial that the injured patient is properly informed about the presumed aetiology, prognosis for spontaneous recovery, treatment options when no spontaneous recovery is observed, and guided in reporting the injury to the compensation system. The Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital, has the national responsibility for surgical reconstruction following nerve injuries, but only receives a limited number of referrals yearly. Even these are often referred late, thereby compromising the prognosis for surgical treatment and re-establishment of neurosensory function. The purpose of the present article is to explain the aetiology of neurosensory injuries after surgical removal of mandibular third molars, recommendations for timely referral, neurosensory assessment of the type and extent of the injury, options for surgical reconstruction and reporting a claim to the compensation system.