Numbness after implant and bone graft: options?

Cases and Questions
#1

56 yo presented for implant 30 and gbr 29. 24 hr post op pt stated her lip was numb and 1/2 chin. Implant 30 far away for IAN but bone particles close to the foramen. Is this swelling and edema? Should I remove the bone. I was careful in my retraction but could have damaged the nerve at the foramen inadvertently. Would microsurgical repair help this patient?

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#2

Manosteel Manosteel comments:

I think the implant placement is OK. The gbr on 29 may be the problem. Possibly some damage to the IAN and Mental nerve occurred when debriding, decorticating or placing the graft . When doing a periosteal releasing incision and spreading the flap some segments of the nerve may have been cut or damaged. One has to expose the mental nerve at the foramen to note its location then avoid the area around it making a release to the mesial and distal. of the nerve. You might consult a neurologist or oral surgeon? or just inject the area with dexamethasone and re evaluate in 2 wks These are just my thoughts I'm sure there are others out there.
#3

Dennis Flanagan DDS MSc comments:

There may be an oseous compression. Pulp test all the teeth and map the area of numbness to determine the extent of the altered sensation. After 4 weeks a referal may be indicated. Dexamethasone or Neurontin have been used in the past. There may be retained infefcted bone, the CBCT seems radiolucent.
#4

YULY GERTSBERG comments:

Anasthesia should be concidered.If it not a 4% SEPTO most of the time shoud be resolved.#29 AREA MIGHT BE 1ST CONCERN. IF IN 2 MONTHS NO IMPROVMENT -NERVE REPAIR SPECIALIST - ORAL SURGEON CONSULTATION - MUST
#5

Indraniil Roy comments:

Did you give a vertical release incision near 29 or 28?
#6

Dr K G comments:

Possibly nicked the mental nerve on flap preparation. Refer immediately to reconnect the nerve.
#7

Tim Carter comments:

If you plan to work in this area then be prepared for such. The most likely etiology is trauma from soft tissue manipulation in the area of the mental foramina. Usually the sensation will return gradually over the course of 2-4 weeks but it could take up to 12 weeks. Years ago I had this happen and at 3 months I was ready to concede that she had lost sensation but on the first day of the 4th month it completely returned. It can happen and it will likely resolve spontaneously just be patient.