Patient developed paresthesia after apicoectomy: thoughts?

Patient was referred to Endo for apicoectomy #11. Now 6 months after treatment was provided, the patient has developed permanent paresthesia of the upper left lip near the surgical site. Could this be due to facial nerve damage or due to infraorbital nerve damage? Also, can this be related to flap technique above mucogingival junction to get access to the apex of the root? Is there a special precautionary protocol one must follow to avoid this type of nerve injury? Your help as well as input in this matter is greatly appreciated.

4 thoughts on “Patient developed paresthesia after apicoectomy: thoughts?

  1. mpedds says:

    The Facial Nerve VII supplies motor innervation to the muscles of facial expression. I believe the branch that supplies the elevator muscles of the upper lip exit the stylomastoid foramen beneath the ear and travel in the fascia to the muscles. There should be no damage to this nerve from routine dental surgery. If by paresthesia you mean there is a sense of the lip being numb, the Anterior Superior Nerve (ASA) is a sensory branch of the Trigeminal Nerve V1. It is usually found in this area.

    Injuries to this nerve could be possible depending on surgical technique.

  2. Dr. Bob says:

    Refer back to the surgeon. If the surgeon is not available refer to a neurologist. Using careful surgical technique when doing this procedure would not result in this type of a problem. An area of the gingiva over the tooth might even be expected to loose sensory innervation, but the loss of motor function would not have been caused by this procedure. There has to be another cause for this complaint and it could be serous. Failure to recognize the need for a referral could be a problem. CYA

  3. Wesley Haddix says:

    Sorry to hear this. First: “Now 6 months after treatment was provided, the patient has developed permanent paresthesia of the upper left lip near the surgical site. ” Did the parasthesia develop immediately after surgery, suggesting damage during surgery, or did it develop over time, suggesting the process is due to nerve encapsulation or apoptosis. Sensation to the upper lip is primarily from the infaorbital nerve; owing to its proximity to the apex of tooth 11, this nerve can be damaged by retraction during apical surgery of tooth 11. Radigraphs including CBCT and photos of the area of parasthesia should be obtained. In addition to referral to an OMFS, there has been success in treating these cases with ND:Yag lasers. Best of wishes to you and your patient.


Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Questions, Surgical.
Bookmark Patient developed paresthesia after apicoectomy: thoughts?

Videos to Watch:

Extraction and Immediate Implant with Luxator LX

Extraction of tooth #8, using Luxator LX, and then an immediate implant and provisional.[...]


Watch Now!
Dealing with the Implant Gap

This short video discusses how to best deal with the gap after immediate implant insertion[...]

1 Comment

Watch Now!
Lower Right Molar Extraction & Immediate Implant Placement Using i-PRF

In this video, the lower right second molar was extracted and grafted with i-PRF and[...]


Watch Now!
Maxillary Implantation with Treatment of Chronic Sinusitis

This video shows two cases where implants were placed following treatment of Sinusitis. [...]


Watch Now!
Suturing in Guided Bone Regeneration

This video provides clinical tips for suturing techniques in Guided Bone Regeneration. In Guided Bone[...]

1 Comment

Watch Now!
Socket grafting with Collagen Dressing and Bond Apatite

This video demonstrates socket grafting with just bond apatite and a collagen wound dressing.[...]

Watch Now!
Dental Implant for Lower Right Second Molar

This video shows implant placement on the lower right second molar.[...]

Watch Now!
Saving a Bridge with Periodontal Therapy

This video shows a case involving a 48-year-old male who was referred for periodontal treatment[...]

Watch Now!
Immediate Loading Full Arch

This video shows a case of Immediate loading of a full arch with simultaneous guided[...]

Watch Now!
Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, that may help the long[...]

Watch Now!
Digitally Planned Bone Augmentation and Immediate Implantation

This video shows a case using the Ring technique to provide bone augmentation along with[...]

Watch Now!
AnyRidge Implants: Replacement of Upper Left Molars

This video shows the replacement of maxillary upper left molars with Megagen AnyRidge Implants.[...]

1 Comment

Watch Now!