Trigeminal nerve microsurgery · New Jersey
Nerve Injury and Repair
Evaluation and microsurgical repair of inferior alveolar and lingual nerve injuries after wisdom tooth removal, dental implants, jaw surgery, or trauma. Nerve injuries are evaluated by referral from the treating dentist or surgeon.
Medically reviewed by Benjamin Subtelny, DDS, board-certified oral and maxillofacial surgeon
The nerves
Two Nerves That Run Close to the Teeth
The inferior alveolar nerve runs through the lower jaw and gives feeling to the lower lip, chin, and lower teeth. The lingual nerve runs in the soft tissue on the tongue side of the lower jaw and gives feeling and taste to the side of the tongue. Both run close to the lower teeth, especially the wisdom teeth, and both can be injured during wisdom tooth removal, implant placement, a local anesthetic injection, jaw surgery, or a fracture.
These injuries can follow procedures that were performed carefully, and many recover on their own. The ones that do not recover are time-sensitive.
Timing Matters
For injuries that are not improving, or that are causing pain, results are best when repair is performed early, ideally within the first three months. New numbness, tingling, or burning after a dental procedure should be evaluated promptly rather than watched for months without significant improvement.
Referring doctors can call directly for a prompt appointment: (201) 509-5648
Symptoms
What Patients Notice
- Numbness of the lower lip, chin, gums, or tongue
- Tingling or a pins-and-needles feeling
- Burning or electric pain in the lip, chin, or tongue
- Loss of taste on one side of the tongue
- Biting the lip or tongue without noticing
- Drooling or difficulty with speech from loss of sensation
Evaluation
Measuring the Injury
Each visit includes standardized neurosensory testing: light touch, two-point discrimination, brush direction, pinprick, and temperature, graded on the Medical Research Council scale. For inferior alveolar nerve injuries, a cone-beam CT scan shows whether an implant, bone fragment, or tooth root is pressing on the nerve. Repeating these tests over the first weeks shows whether the nerve is recovering. That trend, together with how severe the loss of feeling is and whether there is pain, guides the decision to operate. Repair can improve sensation but usually does not return it to normal, so surgery is generally not recommended for a mild loss of feeling.
Treatment
Treatment Options
- Observation With Testing
- For injuries that are steadily improving.
- Removing the Cause
- An implant, bone fragment, or tooth root pressing on the nerve may need to be removed early to give the nerve its best chance.
- Neurolysis
- Freeing the nerve from surrounding scar tissue or bone.
- Direct Repair (Neurorrhaphy)
- The injured ends are trimmed, aligned, and sutured under the operating microscope.
- Nerve Grafting
- When a gap remains, or a damaged part of the nerve must be removed, the gap is bridged with a processed nerve allograft, which is a donated nerve for grafting, so no nerve needs to be taken from elsewhere in your body.
- Nerve Pain
- When burning or electric pain is part of the picture, medication is coordinated with a pain specialist alongside surgical care.
For dentists
For the Referring Dentist
A nerve injury is stressful for the patient and for the dentist who treated them. Dr. Subtelny's consultation focuses on the path forward for the patient, not on assigning blame. His reports are factual and clinical, and he keeps the referring dentist informed at each stage of testing and treatment. Early referral helps the patient most; you do not need to wait to see whether sensation returns.
Questions
Common Questions
Will the feeling come back on its own?
Many injuries improve, especially when the nerve was stretched or compressed rather than cut. Testing over the first weeks shows which direction it is heading.
How soon should I be seen?
Start with the dentist or oral surgeon who performed the procedure. If numbness, tingling, or pain is not improving after one to two months, ask them for a referral, since evaluation within the first few months gives the best chance if repair is needed. If the nerve is known to have been cut, or an implant may be pressing on it, the referral should be made right away.
Is it too late if it has been a year?
Repair is sometimes still worthwhile after a year, though results are generally better when it is done earlier. An evaluation is the only way to know.
Is nerve repair covered by insurance?
Nerve repair is billed to medical insurance. Our office prepares the documentation and requests prior authorization.
For referring doctors
Refer a Nerve Injury
Nerve injuries are seen by referral, with prompt appointments. Call directly or send records through the referral page.