Pippi Roberto, Spota Andrea, Santoro Marcello
Associate Professor, Department of Odontostomatological and Maxillo Facial Sciences, "Sapienza" University of Rome, Rome, Italy.
Researcher, Department of Odontostomatological and Maxillo Facial Sciences, "Sapienza" University of Rome, Rome, Italy.
J Oral Maxillofac Surg. 2018 Aug;76(8):1651.e1-1651.e13. doi: 10.1016/j.joms.2018.03.020. Epub 2018 Mar 27.
The aim of this review is to improve risk management strategies through analysis of the anatomic, semeiotic, and medicolegal aspects that characterize iatrogenic lingual nerve damage (LND) and its legal consequences in the case of legal proceedings for a claim for compensation. In dental practice, LND can be caused by local or general anesthesia or by mechanical, chemical, or thermal mechanisms. A certain postoperative identification of LND etiopathogenesis is often very challenging because it can be difficult to show at what time the damage occurred and which mechanism actually caused it. Clinical tests assessing lingual nerve sensory capabilities have a low sensitivity and moderate specificity, whereas instrumental tests have the advantage of not being affected by data interpretation subjectivity by both the operator and the patient. The quantification of permanent LND is not uniformly established, and there are no specific standard worldwide indications. From a medicolegal point of view, LND is a complication that may or may not be caused by surgical error. The 2 different concepts of "expectability" and avoidability or preventability allow one to discriminate between professional liability and fate and therefore to determine the surgeon's imputability in LND. Despite clinical competence and practice in performing the medical or surgical procedure, the clinician risks a lawsuit for negligence if he or she does not warn the patient about all relevant risks regardless of their frequency. Informed consent plays an essential role in minimizing litigation; the patient must be informed-with both his or her level of culture and ability to understand being taken into consideration-of the diagnosis, prognosis, and therapeutic perspectives and their consequences, in addition to all other viable alternative therapies, as well as the risks of nontreatment.
本综述的目的是通过分析医源性舌神经损伤（LND）的解剖学、症状学和法医学方面及其在索赔法律程序中的法律后果，来改进风险管理策略。在牙科实践中，LND可能由局部或全身麻醉或机械、化学或热机制引起。对LND病因发病机制进行一定的术后识别往往非常具有挑战性，因为可能难以确定损伤发生的时间以及实际导致损伤的机制。评估舌神经感觉能力的临床测试敏感性低、特异性中等，而仪器测试的优点是不受操作者和患者数据解释主观性的影响。永久性LND的量化尚未统一确定，全球也没有具体的标准指征。从法医学角度来看，LND是一种可能由手术失误引起也可能不由手术失误引起的并发症。“可预期性”和可避免性或可预防性这两个不同的概念使人们能够区分职业责任和命运，从而确定外科医生在LND中的可归责性。尽管临床医生在进行医疗或外科手术方面有能力且有实践经验，但如果他或她没有告知患者所有相关风险（无论其发生频率如何），仍有可能因疏忽而面临诉讼。知情同意在减少诉讼方面起着至关重要的作用；除了所有其他可行的替代疗法以及不治疗的风险外，还必须根据患者的文化水平和理解能力，告知患者诊断、预后、治疗前景及其后果。
