Injury to the sensory branches of the nerves to the face and oral structures can occur due to a variety of reasons including trauma, or as being a known risk for common oral surgical procedures such as wisdom tooth removal, dental implant placement, root canals, tumor removal, and injection of local anesthesia. Many of the injuries to these nerves are temporary and return completely or near completely within weeks to months which is why it is not uncommon to delay surgery for weeks to allow for recovery of the nerve. Occasionally, do the major nerves need to be repaired and this is typically when it is evident that the nerve has been severed. This most commonly happens to the nerve that supplies sensation to the tongue and the nerve that supplies sensation to the lower lip and chin. This can be done in the operating room with the use of a surgical microscope. The decision to repair the nerves are individual and depend on the impact on the patient’s daily life, the nature of the injury, and the time from the injury.
Injury can also occur to the nerve that allows the muscles of the face to move. This can be due to trauma (usually laceration), tumor removal, as well as being a known risk to many surgical procedures in the face. As in the sensory nerves, many of the injuries will resolve spontaneously. The most common reason for surgical exploration and repair is a known or suspected laceration of the nerve in the area in front of the ear which is where the nerve is largest and before it separates in to multiple small branches. Again, repair is done with the surgical microscope in the operating room and the decision to perform repair is based on the impact to the patient, the cause, and time from the injury.
One of the additional procedures that can be necessary with microneurosurgery is nerve grafting. This is where a nerve from a different part of the body (typically a sensory nerve in the neck or on the back of the lower leg) is used to connect two sections of healthy nerve. The need for this is rare and is something that our surgeons would discuss with you based on the nature of your injury.
We are one of very few practices along the eastern seaboard and the entirety of New England that offer this type of surgery, and the only in the seacoast region.