Oral Surgery · patient case question
Which two nerves are at greatest risk of injury during removal of an impacted mandibular third molar?
Patient case: Third Molar Surgery and Its Complications
demo: 24-year-old female
chief: “The gum over my lower wisdom tooth is swollen and I can barely open.”
history: Smokes 10 cigarettes daily. Takes combined oral contraceptives. Poor oral hygiene.
meds: Combined oral contraceptive pill
findings: Partially erupted #17 with an inflamed, edematous operculum, purulent exudate on pressure, trismus, and tenderness. Extraction is planned. Four days after a previous extraction of #32, she developed severe radiating pain with an empty socket and exposed bone.
Show answer and explanation
Correct answer: B. Inferior alveolar and lingual nerves
- A. The facial nerve is extraoral and well away from the surgical field; the hypoglossal is deep in the floor of the mouth.
- B. Correct. The IAN lies apical or in contact with the roots, and the lingual nerve lies immediately deep to the lingual plate at this level — both are the classic surgical hazards.
- C. The mental nerve is at risk in the premolar region, not at the third molar; the infraorbital nerve is maxillary.
- D. The glossopharyngeal and vagus nerves are not within the surgical field.