Numb lower lip after third molar removal

§Chief complaint

Lower lip and chin still numb 3 weeks after wisdom tooth removal

§Medical & dental history

• 01Healthy
• 02Horizontal impacted 38 removed 3 weeks ago; roots close to the nerve on OPG

§Clinical examination

• 01Reduced sensation of left lower lip and chin, mapped and photographed
• 02Light touch and two-point discrimination reduced; no pain
• 03Socket healing normally

§Figures

§Differential diagnosis

§Final diagnosis

Left inferior alveolar nerve injury after removal of 38

Numbness in the nerve's area after surgery at a site where the canal was close to the roots, with partial feeling remaining, suggests a bruising-type injury with a good chance of recovery.

§Investigations

• 01Sensory mapping with light touch, pin-prick and two-point discrimination at each visit
• 02CBCT to check for a root fragment in the canal

§Radiology

• 01CBCT — socket close to the canal, roof of canal broken, no fragment in the canal

§Treatment plan

• 01Explanation and reassurance
• 02Regular sensory mapping at 1, 3 and 6 months
• 03Refer for microsurgical repair if no recovery by 3-6 months

§Follow-up & outcome

• 01Month 1 — area reduced by a third
• 02Month 3 — tingling returning
• 03Month 9 — near-normal feeling

Outcome: Near-complete recovery at 9 months without surgery.

§Discussion

• 01Most injuries are temporary: about 1 in 100 numb lips after third molar surgery are permanent.
• 02Coronectomy can prevent this injury when roots are close to the nerve.

§Clinical pearls / learning points

• 01Map and photograph the numb area at every visit — it shows progress clearly.

§Viva questions

§MCQs

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