Management and sensory outcomes of iatrogenic inferior alveolar nerve injury after dental and oral surgical procedures: a systematic review and clinical workflow.

OBJECTIVES

To synthesize the aetiology, management, timing, and sensory outcomes reported after unintended iatrogenic inferior alveolar nerve injury (iIANI).

STUDY

DESIGN

A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Google Scholar were searched for studies of iIANI unintentionally caused by dental or oral and maxillofacial procedures. Outcomes included aetiology, intervention, interval from injury to repair, functional sensory recovery (FSR), and other sensory outcomes. Bias risk was assessed using the Newcastle-Ottawa Scale.

RESULTS

Seven reports and 209 IAN injuries with a clearly classifiable unintended iatrogenic aetiology were included. Medical Research Council-defined functional sensory recovery was reported in two predominantly iatrogenic series: 10/16 patients after nerve-sliding repair and 7/9 after surgery for endodontic overfilling. Other studies used neurophysiological improvement, continuous neurosensory measures, symptom resolution, or outcomes that could not be separated by nerve or aetiology. Grafts were used in 11/80 patients. Study-level timing findings generally favoured prompt assessment and referral, although confounding prevented definition of a universal operative threshold.

CONCLUSIONS

iIANI may cause persistent neurosensory impairment. Microsurgical repair can improve sensation in selected patients, but outcome definitions and reporting were heterogeneous. Early specialist assessment, standardised sensory testing, and aetiology-specific prospective studies are needed.