# Challenges in Diagnosing the Course of the Lingual Nerve for Clinical Practice and Research

## TL;DR

This review discusses the challenges in tracing the lingual nerve during oral surgery to prevent complications like loss of taste and chronic pain.

## Contribution

The paper systematically reviews literature to highlight anatomical challenges and diagnostic limitations in identifying the lingual nerve's course.

## Key findings

- Difficulties in tracing the lingual nerve occur at multiple anatomical sites, including the foramen ovale and retromolar regions.
- Lingual nerve injury is common during lower third molar surgeries, influenced by factors like patient age and surgical approach.
- Imaging tools like MRI and ultrasound may help but face practical limitations, while regenerative therapies need more validation.

## Abstract

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.