Responsabilidade profissional por lesão do nervo lingual durante exodontia de terceiro molar inferior: análise de nove processos judiciais / Professional responsibility for lingual nerve injury during lower third molar extraction: analysis of nine court proceedings

Introdução: A remoção cirúrgica dos terceiros molares inferiores apresenta o risco potencial de lesões a estruturas nobres como o nervo lingual devido sua localização anatômica. O grau de comprometimento do nervo indicará se a lesão é transitória ou permanente. A injúria nervosa pode motivar o paciente a acionar judicialmente o cirurgião-dentista, e sendo evidenciada a culpa profissional, caberá a reparação pecuniária dos danos causados ao paciente, sejam de natureza material ou moral. Objetivo: Analisar nove decisões judiciais de 1ª e 2ª instância, disponíveis no site do Tribunal de Justiça de São Paulo (TJSP), motivadas pela lesão do nervo lingual durante a exodontia de terceiro molar inferior. Metodologia: Após a leitura e análise foram extraídas informações como: perfil das partes, tempo de duração dos processos, procedência ou não da ação, valor da indenização, responsabilidade profissional e presença de TCLE. Resultados: Na primeira instância, seis dos nove casos foram julgados improcedentes; em segunda instância, quatro destas sentenças foram reformadas para procedência. No total, após decisão de segunda instância, houve procedência da ação em sete dos nove casos. Nas ações procedentes, as indenizações para dano moral variaram de R$ 5 mil a R$ 50 mil, sendo a imperícia e negligência as modalidades de culpa mais atribuídas aos profissionais. Conclusão: Sabendo-se que a lesão do nervo lingual durante a extração de terceiro molar inferior, mesmo previsível, nem sempre é evitável, verifica-se a importância do TCLE (ou documento similar) na prática clínica como instrumento de defesa jurídica do profissional, diante da alegação de falha de informação. Este documento foi mencionado em apenas três dos nove casos processuais, sendo em que em dois destes não houve constatação de falha técnica ou de informação (ação improcedente nas duas instâncias)

Introduction: Surgical removal of lower third molars presents the potential risk of injury to noble structures such as the lingual nerve due to its anatomical location. The level of nerve involvement will indicate whether the injury is transient or permanent. Nervous injury can motivate the patient to sue the dentist, and if professional guilt is evidenced, it will be up to pecuniary compensation for the damage caused to the patient, whether of a material or moral nature. Objective: To analyze nine court decisions of 1st and 2nd instances, available on the Court of Justice of State of São Paulo (Brazil) website, motivated by lingual nerve injury during lower third molar extraction. Methodology: After reading and analysis, information was extracted such as: profile of the litigating parties, duration of the processes, judge decision for the action, indemnity value, professional responsibility and presence of TCLE. Results: In the first instance, six of the nine cases were dismissed, the sentence was reformed in four cases, confirming the merits of the action in seven of the nine cases. In the cases of valid actions, compensation for moral damages ranged from R$ 5 thousand to R$ 50 thousand, with malpractice and negligence being the types of fault most attributed to professionals. Conclusion: Knowing that lingual nerve injury during mandibular third molar extraction, even if predictable, is not always avoidable, the importance of the informed consent (or similar document) in clinical practice as an instrument for the professional's legal defense is mandatory, to avoid the allegation of miss information. This document was mentioned in only three of the nine cases, and in two of these there was no finding of technical or information failure (unfounded action in both instances)

Reconstrucción microquirúrgica del nervio lingual / Microsurgical lingual nerve repair

Resumen Introducción: El daño del nervio lingual posterior a un evento traumático es frecuente durante algunos procedimientos en cirugía maxilofacial. Siendo la desinclusión de terceros molares la causa más frecuente. La reconstrucción microquirúrgica del nervio es una técnica eficaz con éxito sobre el 80% de los casos. Objetivo: El objetivo de este artículo es presentar dos casos de reconstrucción microquirúrgica del nervio lingual. Casos Clínicos: Pacientes de sexo femenino tratadas por el equipo de Cirugía Maxilofacial del Hospital Dr. Abraham Godoy Peña. Donde se les realiza la reconstrucción microquirúrgica del nervio lingual, ambas presentan resultados positivos al año y medio, con una recuperación funcional sensorial (FSR +) y sensorial positiva S3 y S4+ respectivamente para cada paciente. Discusión: El momento de la reconstrucción microquirúrgica del nervio lingual no está bien definido. Sin embargo, la mayoría de los autores sugieren un tratamiento quirúrgico temprano, antes de los 6 meses. El daño del nervio lingual a menudo afecta la calidad de vida del paciente. La reconstrucción microquirúrgica del nervio lingual debe ser incorporada dentro del algoritmo de tratamiento del daño del nervio lingual.

Introduction: Lingual nerve injury after a traumatic event is frequent during some maxillofacial procedures, being the third molar extraction the most frequent cause. Lingual nerve injury may be performed in different grades of damage and it is often invalidating. Microsurgical reconstruction is an efficacy technique with a rate of success over 80%. Aim: To present two cases of lingual nerve microsurgical reconstruction after lingual nerve injury. Clinical Cases: Two female patients suffered lingual nerve injury after third molar extraction, both were submitted to lingual nerve reconstruction. It was performed the microsurgery reconstruction of the lingual nerve, both present favorable outcomes follow up to 1.5 years, including positive Functional sensory recovery (FSR +) and sensorial test S3 and S4+ respectively for each patient. Discussion: The timing of lingual nerve microsurgery is not well defined; however, most authors suggest an early surgical treatment before 6 months. The lingual nerve injury often affect the quality of life of the patient. Microsurgery reconstruction should be incorporated into the treatment algorithm of lingual nerve injury.

Dexamethasone treatment for bilateral lingual nerve injury following orotracheal intubation

Lingual nerve injury is a rare complication of general anesthesia. The causes of lingual nerve injury following general anesthesia are multifactorial; possible mechanisms may include difficult laryngoscopy, prolonged anterior mandibular displacement, improper placement of the oropharyngeal airway, macroglossia and tongue compression. In this report, we have described a case of bilateral lingual nerve injury that was associated with orotracheal intubation for open reduction and internal fixation of the left distal radius fracture in a 61-year-old woman. In this case, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.