Transection or avulsion of; lingual nerve
CPT4 code
Name of the Procedure:
Common name(s): Transection or avulsion of the lingual nerve
Technical/medical term: Lingual nerve injury management
Summary
In simpler terms, this procedure involves surgical intervention on the lingual nerve, commonly found in the mouth, to either cut (transect) or pull out (avulse) the nerve. This is often performed to alleviate pain or other symptoms arising from nerve damage or entrapment.
Purpose
The purpose of this procedure is to address issues related to the lingual nerve, such as persistent pain, numbness, or other sensory disturbances. The goal is to relieve symptoms that are unresponsive to other treatments and improve the patient’s quality of life.
Indications
- Chronic or severe pain along the lingual nerve path.
- Numbness or altered sensation in the tongue and surrounding areas.
- Failed conservative treatments such as medications and physical therapy.
- Patients showing signs of nerve entrapment or damage confirmed through diagnostic tests.
Preparation
- Patients may need to fast for several hours prior to the procedure.
- Pre-procedural assessments might include physical exams, imaging studies like MRI, or nerve conduction tests.
- Patients may need to adjust or discontinue certain medications as advised by their healthcare provider.
Procedure Description
- Anesthesia: The procedure typically begins with local or general anesthesia to numb the area or render the patient unconscious.
- Incision: A small incision is made in the mouth near the area where the lingual nerve is located.
- Identification: The surgeon carefully locates the lingual nerve.
- Transection or Avulsion: Depending on the specific case, the surgeon either severs (transects) the nerve or removes a section of it (avulsion).
- Closure: The incision is meticulously closed with sutures, and the area may be dressed to prevent infection.
Tools and equipment used might include surgical scalpels, forceps, nerve hooks, and suturing materials.
Duration
The procedure usually takes between 30 to 60 minutes.
Setting
The procedure is performed in a hospital or an outpatient surgical center where appropriate anesthesia and sterile conditions can be ensured.
Personnel
- A specialized oral or maxillofacial surgeon will perform the procedure.
- An anesthesiologist or nurse anesthetist will manage the anesthesia.
- Surgical nurses or assistants will support the surgeon during the procedure.
Risks and Complications
- Infection at the incision site.
- Bleeding or hematoma formation.
- Temporary or permanent altered sensation post-surgery.
- Pain or discomfort at the surgical site.
- Rarely, damage to surrounding structures.
Management of complications includes antibiotics for infections, pain medications, and follow-up visits to monitor healing.
Benefits
The primary benefit is the reduction or complete relief of symptoms like pain and numbness. Improvement is typically noticed within several weeks to a few months after the procedure.
Recovery
- Patients are usually discharged the same day with instructions on wound care.
- Pain management may involve prescribed analgesics.
- Avoiding irritating foods and practicing good oral hygiene.
- Follow-up visits are necessary to assess healing and nerve function.
- Full recovery can take several weeks to months, with gradual return to normal activities.
Alternatives
- Conservative therapies such as medications, physical therapy, or nerve blocks.
- Non-surgical options like laser therapy or radiofrequency ablation.
- The choice of alternatives depends on the cause and severity of symptoms, with varying degrees of effectiveness and invasiveness.
Patient Experience
During the procedure, patients will not feel pain due to anesthesia, although there might be soreness at the injection site afterwards. Post-procedure, mild to moderate pain or discomfort is common but manageable with pain relief measures. Follow-up care ensures proper healing and the effectiveness of symptom management.