Trigeminal Nerve Injuries

The trigeminal nerve constitutes the largest sensory cortex representation in the brain compared to any other sensory nerve. This is likely due to the fact that the trigeminal nerve underpins our very existence, as it protects, sensorially, our senses including the organs that provide sight, smell, taste, hearing, speech and meninges protecting our brain.Neurophysiologically, our affective and limbic systems in our brains are alerted before we even set foot in the dental surgery and the patient’s brain is anticipating and aligned for pain experience. Thus, when trigeminal nerve injuries occur, which in the main are preventable, the majority of patients experience mixed symptoms including ongoing and elicited neuropathic pain, numbness and altered sensation. These neuropathic features cause significant impact on the patients’ ability to function, for example, cold allodynia prevents the patient enjoying cold foods and drinks and undertaking outdoor activities or elicited pain on touch frequently interferes with sleep. The resultant chronic symptoms and functional impedance often result in significant psychological morbidity.There is no magic bullet to resolve these sensory nerve injuries, and our specialty is beholden to prevent nerve injuries where possible. The patient must have the appropriate consent, and their expectation is managed with understanding the potential benefits and risks for their chosen interventions.Prevention and management of nerve injuries related to local anaesthesia, implants and third molar surgery are outlined in this chapter. There is insufficient capacity to go in-depth for each area, but the author has provided up to date evidence base where it exists and some strategies to minimize and manage optimally these unfortunate complications.