The Significance of the Lingual Nerve During Periodontal/Implant Surgery

Background: Understanding the position of the lingual nerve is important when performing third molar extractions and periodontal and implant surgeries in the mandible. The careless management of the lingual flap can potentially cause damage to the lingual nerve. The location of the lingual nerve in the third molar region was described in the literature; however, to our knowledge, its course mesial to the third molar region was not reported. The aim of this study is to identify and measure the location of lingual nerves in relation to mandibular teeth in fresh cadaver heads. Methods: Thirty lingual nerves from 18 cadaver heads were dissected, and the vertical distance from the lingual nerve to the mid-lingual cemento-enamel junctions of mandibular molars and premolars and the position where the lingual nerve left the lingual plate and moved toward the tongue were determined. Two cadaver heads were randomly selected and exposed to cone-beam computed tomography (CBCT) scans after the insertion of a wrought wire into the nerve. The same vertical distance as the clinical measurement was determined and compared. Results: Seventy-five percent of lingual nerves turned toward the tongue at the first and second molar region. The vertical distance was 9.6, 13, and 14.8 mm at the second molar, first molar, and second premolar, respectively. The difference between clinical and CBCT measurements was 0.57 +/- 2.62 mm. Conclusions: The course of the lingual nerve in relation to posterior teeth was described. This information can help surgeons gain more understanding of the location of the lingual nerve and perform safe surgeries in the mandible. J Periodontot 2010;81:372-377.