Anatomy of the lingual nerve in relation to possible damage during clinical procedures.

Damage to the lingual nerve, resulting in transient or permanent paraesthesia or anaesthesia, is a common undesirable complication of surgical interventions to the lower third molar region. The anatomy of the nerve, as it travels from its origin high in the infra-temporal fossa, to the floor of the mouth is quite variable. The most critical part of its course is where it enters the sublingual region just alongside the lingual alveolar plate of the lower third molar. A significant number of lingual nerves are located above the alveolar bone in the gingival tissues, or very close to the bone. Retraction of the lingual mucosa can lead to lingual nerve trauma. There is no doubt that the lingual nerve is extremely vulnerable in this region and clinicians must assume that it is closely adjacent to the lingual region of the lower third molar, in all cases, in order to minimize possible damage.