Inferior Alveolar Nerve Paresthesia After 3rd Molar Removal

Abstract

Paresthesia of the inferior alveolar nerve (IAN) is a known complication affecting patients who have their third molars extracted, but it is considered rare. It is known that if the third molar roots are in proximity to the mandibular canal, the risk of injury and disturbance to the neurosensory system, which may be temporary or permanent, may occur. In this study, a 28-year-old female had her impacted mandibular left third molar removed. Prior to the surgery, a panoramic X-ray and a cone beam computed tomography (CBCT) were performed, which showed contact of the molar roots with the mandibular canal. Post-surgery, the patient had reported paresthesia of the left IAN, and the clinician had confirmed by testing that there was a loss of light touch, an impairment of pin prick, and changed thermal perception. Paresthesia was treated conservatively with corticoids, B-complex vitamins, pain medications, and monitoring of the neurosensory system. Monitoring was performed with appointments post-op, at 1 week, 1 month, 3 months, and 6 months. By the sixth month post-op, paresthesia was resolved, and normal function returned to the site. The case shows the need for detailed reading of the pre-op imaging. For patients with high-risk root-canal proximity cases, the post-op care shows that recovery for IAN injury from the third molar surgery has a better outcome with early diagnosed and treated care with follow-up.