Lingual Nerve Risk Third Molar — ORE Part 1 MCQ

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EasyOral SurgeryLingual Nerve Risk Third MolarORE Part 1

Which nerve is at risk during raising of a buccal mucoperiosteal flap for surgical extraction of a lower third molar?

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Correct answer: D — Lingual nerve

The lingual nerve is at primary risk during lower third molar extraction due to its anatomical proximity to the lingual bone plate, which lies 1–7 mm from the tooth. Although the question mentions a 'buccal flap', the surgical approach to an impacted lower third molar necessarily involves work near the lingual aspect of the mandible, placing the lingual nerve at risk, particularly if lingual flap retraction is used (risk ratio 4.80 vs. buccal approach alone). The mental nerve lies anterior in the mental foramen. The buccal nerve and mylohyoid nerve are not at significant risk during third molar extraction. The hypoglossal nerve is proximal to but not directly exposed. Lingual nerve injury is the most common peripheral nerve complication of third molar surgery.

Reference: Jamali Z, et al. Incidence of lingual nerve damage following surgical extraction of mandibular third molars with lingual flap retraction: A systematic review and meta-analysis. JAMA Netw Open. 2023;6(2):e2258717. https://pubmed.ncbi.nlm.nih.gov/36848347/