NK nestor d. Karas, DDS,MD
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Evaluation & Treatment of Nerve Injuries
What Causes Nerve Injuries?
Nerve injuries which supply the sensation in your face, jaws, teeth, gums, lips, or tongue can be caused by trauma, surgery and sometimes dental procedures such as root canal fillings, wisdom teeth removal, insertion of implants, correct jaw deformities, or other procedures. Soft tissue lacerations and facial bone fractures can cause significant nerve injuries. Local anesthetics (such as “Novocaine”) can also trigger nerve injury. Despite the best of care provided, nerve injuries are an inherent risk of any dental or surgical procedure.
How Do I Know if I Have a Nerve Injury?
You may experience a variety of sensations, most of them are unpleasant: numbness, tingling, crawling sensations, burning, hypersensitivity of the affected area, or electric shocks are some symptoms of a nerve injury. These sensations can interfere with normal activities such as chewing, speaking, drinking of liquids, washing, smoking, kissing or shaving and can cause distress to the patient. If these symptoms persist longer than one month following surgery, the nerve injury will likely not resolve on its own without other treatment or surgical intervention.
What are the Different Types of Nerve Injury?
Many types of nerve injury can arise, which include:
• Compression of the nerve by tooth or bone fragments (see Figure 1), scar tissue, or foreign material such as bone fixation screws, dental implants, or plates or wires.
• Burns from corrosive substances such as medications or root canal filling materials.
• Stretching from a traumatic injury or manipulation during surgery.
• Partial or complete severance of the nerve causing an interruption or discontinuity, or the growth of a neuroma (a mass of nerve tissue that can be quite painful).
  Figure 1: Tooth Fragment Compressing The Nerve
What are My Treatment Options?
Depending on the type and severity of injury, one or more of the following procedures can be done:
• Decompression – the nerve is relieved of any material or tissue pressuring it.
• Nerve Grafting – the lost portion of the nerve is replaced by a sensory nerve graft taken from either the posterior portion of the   lower leg or the neck.
• Neurolysis – removes scar tissue inside the nerve
• Suturing – the two ends of the nerve that are severed are held in place with precise stitches.
• Removal – of any abnormal nerve tissue or a neuroma.
What Factors Maximize the Chance of Recovery?
• How quickly the surgery is performed after the injury – the best outcome occurs when the injury is repaired within three to six months. Later repair can be successful, if the tissue beyond the injured area has not undergone permanent deterioration.
• The surgeon’s skill level – Microneurosurgery is a demanding skill. Nerve operations need to be done frequently to maintain skills. Dr. Karas possesses microneurosurgery skills and keeps his skills up to date.
After your examination, Dr. Karas will discuss with you the type of nerve injury you have, the possible methods of treatment available, and the best outlook for improved sensation.
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This material does not constitute medical advice. It is intended for informational purposes only.Please consult a physician or dentist for specific treatment recommendations.