Lingual Nerve Injury — ORE Part 1 MCQ

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HardOral SurgeryLingual Nerve InjuryORE Part 1

During surgical extraction of an impacted lower left third molar, which combination of tooth position and local anatomy confers the greatest risk of lingual nerve injury?

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Correct answer: B — Lingual inclination with a thin lingual plate

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · B = shown as D · C = shown as E

A is correct. Lingual inclination is associated with a greater risk of lingual nerve injury during lower third-molar surgery. A thin or perforated lingual cortical plate also removes the bony barrier between the surgical field and lingual soft tissues; lingual-plate perforation is an independent predictor of lingual nerve injury. Together, these features make direct trauma, displacement towards the lingual tissues, or injury during lingual manipulation more likely. Buccal inclination and thin buccal bone direct the operative difficulty away from the lingual tissues. Vertical and mesial positions do not provide the same combined lingual anatomical hazard. Distal inclination can increase operative difficulty, but a thick buccal plate does not create the specific high-risk lingual relationship described in A. UK guidance emphasises that lingual nerve injury is chiefly technique-related, with anatomical differences and surgical difficulty also relevant.

Reference: Faculty of Dental Surgery, Royal College of Surgeons of England. Parameters of care for patients undergoing mandibular third molar surgery, 2021, section “Lingual Nerve Injury”. https://www.rcseng.ac.uk/-/media/Files/RCS/FDS/Guidelines/3rd-molar-guidelines--April-2021-v4.pdf