What to do if a patient presents with an iatrogenic trigeminal nerve injury.

Abstract

Objective: Injuries to branches of the trigeminal nerve can occur during various dental procedures, leading to neurosensory deficits. The aim of this article is to educate those who are not specialized in diagnosis and management of iatrogenic trigeminal nerve injuries what to do if such a situation arises in their practice.

Data sources: Treatment protocols, prospective and retrospective studies, and literature reviews were reviewed.

Results: Patient history, neurosensory testing, and radiographic imaging are used to diagnose trigeminal nerve injuries. Based on findings, patients are either immediately referred to a specialist or managed conservatively. Conservative management includes pharmacologic treatment, neurosensory training exercises, and serial neurosensory testing. Consulting with local oral and maxillofacial surgeons or orofacial pain specialists, contacting local and state societies, or searching for providers on websites such as the American Association of Oral and Maxillofacial Surgeons, Academy for Orofacial Pain, American Board of Orofacial Pain, Oral and Maxillofacial Surgery National Insurance Company, or Axogen are different methods that can be used to find a specialist to refer to if indicated.

Conclusions: Many providers are not trained to diagnose and manage iatrogenic trigeminal nerve injuries. Understanding indications for monitoring, conservative treatment, and when to refer these patients to orofacial pain specialists or oral and maxillofacial surgeons trained in trigeminal nerve microsurgery is critical to maximize positive patient outcomes and to minimize medicolegal exposure. (Quintessence Int 2025;56:154-160; doi: 10.3290/j.qi.b5984306).