Management Algorithm for Iatrogenic Trigeminal Nerve Injuries in Dental Patients

Background: Iatrogenic trigeminal nerve injuries, particularly of the inferior alveolar and lingual nerves, represent a severe and disabling complication of dental procedures such as third molar extractions, implant placement, and endodontic treatment. While up to 90% of such injuries are transient, 10–18% become permanent if symptoms persist beyond six months. The primary pathogenetic mechanism is compression-ischemic syndrome within rigid anatomical canals, where post-traumatic edema leads to axonal hypoxia and demyelination. Purpose: To improve treatment efficacy and reduce rehabilitation time in patients with iatrogenic trigeminal nerve injuries by implementing an early pathogenetic therapy algorithm combining anti-exudative intervention with modern physiotherapeutic methods. Methods: A retrospective and prospective analysis was conducted on 60 patients with iatrogenic injuries to the inferior alveolar and lingual nerves. The main group (n=50) received complex pathogenetic therapy including early anti-edematous agents (glucocorticosteroids, venotonics) and physiotherapeutic methods (low-level laser therapy, magnetotherapy) within 24–72 hours post-injury. The comparison group (n=10) received standard treatment limited to B-complex vitamins and NSAIDs. Results: Complete sensory recovery was achieved in 72% of the main group versus 30% of the comparison group. Mean recovery time was 3–4 months in the main group compared to 6–8 months in the comparison group. Chronic neuropathic pain developed in only 8% of the main group versus 50% of the comparison group. Early dexamethasone administration reduced paresthesia resolution time by 4–6 days and decreased permanent neuropathy risk by nearly 46%. Conclusion: Early initiation of anti-edematous therapy combined with physiotherapeutic methods significantly enhances treatment efficacy, shortens rehabilitation periods, and minimizes the risk of chronic neurological complications following iatrogenic trigeminal nerve injuries.

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