It’s on the tip of my tongue! Prolonged paresthesia of the tongue after dental procedure (P1.9-061)

To describe a case of a 47 year old woman who had tongue numbness that persisted for more than one year after a routine dental procedure that used lingual nerve injections for anesthesia.

Taste innervation of the tongue comes from the lingual nerve branch of Cranial Nerve V3. During dental procedures it is common to inject 2% lidocaine or other anesthetics into the lingual nerve for tongue and gum numbness and inferior alveolar nerve for teeth numbness for comfort measures. it is not uncommon to have temporary paresthesias after routine dental work.

Patient had a deep cleaning procedure in 2017 with bilateral lingual nerve injections. Post procedural, she felt tingling and numbness in the anterior two-thirds of her tongue. She denied having numbness in her teeth, or cheeks. She was seen in clinic one month after and tried on gabapentin to reduce her parethesias but was unsuccessful. A MRI brain and MRA were performed to rule out potential intrahematomal nerve damage but was unremarkable. She saw an oral maxillary surgeon five months after her procedure with Von Frey testing which showed evidence of tongue numbness. There were no interventional options recommended.

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We present an interesting case of a patient who had tongue numbness in the anterior two-thirds consistent with lingual nerve injury with apparent sparing of the inferior alveolar nerves as there is no complaints of numbness anywhere else in the oral cavity. Etiology can be difficult to precisely localize, but the lingual nerve could be damaged by injection needles, anesthetic toxicity to the nerve, or through procedural manipulation. Quality of life can be severely affected in such patients. While some patients spontaneously recover, others may be refractory to medical therapy or have poor prognosis of recovery given the extended length of time without improvement.

Disclosure: Dr. Salim Khan has nothing to disclose. Dr. Zaman has nothing to disclose.