Ngeow Wei Cheong, Tay Hui Wen, Sarna Krishan, Cheah Chia Wei, Raj Mary, Acharya Surendra Kumar, Koo Zhong Zheng, Wey Mang Chek
Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, Division of Oral and Maxillofacial Surgery, Faculty of Health Sciences, University of Nairobi, Nairobi 10110, Kenya.
Diagnostics (Basel). 2025 Jun 25;15(13):1609. doi: 10.3390/diagnostics15131609.
The accurate identification and protection of the lingual nerve during oral surgery are critical to avoid complications such as a loss of taste or sensation and chronic pain. While numerous studies have described the nerve's anatomy and injury outcomes, no consensus exists on the optimal method to trace its full course. This narrative review systematically examined the literature from 2010 to 2024, using databases like PubMed, MEDLINE, Embase, and Google Scholar. Keywords included "Lingual nerve," "Course," "Anatomy," and "Clinical implications," combined with Boolean operators. Studies were selected based on defined criteria, and findings were synthesized to highlight key challenges in diagnosing the nerve's path. This review identifies difficulties at multiple anatomical sites: the foramen ovale, infratemporal fossa, pterygomandibular space, third molar and retromolar regions, premolar/molar areas, floor of the mouth, and anterior gingiva and tongue. Lingual nerve injury, especially during lower third molar surgeries, remains a major concern, often exacerbated by factors like patient age, unerupted teeth, and lingual surgical approaches. Effective prevention hinges on precise anatomical knowledge and meticulous surgical technique. Microsurgical repair remains the primary treatment but often yields unpredictable outcomes. Emerging regenerative therapies show early promise but require further clinical validation. Imaging tools such as magnetic resonance imaging (MRI) and ultrasound may enhance diagnostic accuracy and surgical planning; however, each has limitations in everyday practice. Ultimately, early identification, careful surgical handling, and appropriate imaging support are vital for improving patient outcomes and minimizing the risks of lingual nerve injury.
口腔手术中准确识别和保护舌神经对于避免味觉或感觉丧失以及慢性疼痛等并发症至关重要。尽管众多研究描述了该神经的解剖结构和损伤后果，但对于追踪其全程的最佳方法尚无共识。本叙述性综述系统检索了2010年至2024年的文献，使用了PubMed、MEDLINE、Embase和谷歌学术等数据库。关键词包括“舌神经”“走行”“解剖结构”和“临床意义”，并结合布尔运算符。根据既定标准筛选研究，并综合研究结果以突出诊断该神经走行中的关键挑战。本综述确定了多个解剖部位存在的困难：卵圆孔、颞下窝、翼下颌间隙、第三磨牙及磨牙后区、前磨牙/磨牙区、口腔底部以及前牙龈和舌部。舌神经损伤，尤其是在下颌第三磨牙手术期间，仍然是一个主要问题，患者年龄、未萌出牙齿和舌侧手术入路等因素往往会加剧这一问题。有效的预防取决于精确的解剖学知识和细致的手术技巧。显微外科修复仍然是主要治疗方法，但结果往往不可预测。新兴的再生疗法显示出早期前景，但需要进一步的临床验证。磁共振成像（MRI）和超声等成像工具可能会提高诊断准确性和手术规划；然而，每种工具在日常实践中都有局限性。最终，早期识别、谨慎的手术操作和适当的成像支持对于改善患者预后和将舌神经损伤风险降至最低至关重要。
