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Lingual and Inferior Alveolar Nerve Damage Discussion Site

Subject: "A Very Interesting Case"     Previous Topic | Next Topic
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charlottefr
Member since Feb-22-08
508 posts
Jul-12-08, 05:44 AM (CST)
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"A Very Interesting Case"
 
   There doesn't seem to be much information or references to this case on the internet. Maybe someone else can find out more? I'm curious if Dr. Dolce et al appealed the case judgment furthur? This appeal from the TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN upheld the judgement in favor of Ms. Husak for the amount of $503,923.59. I wonder if she has received any of this monetary compensation yet?? I am so glad that Kirsten Husak won this appeal.

If you're interested in the legal aspect of oral nerve injuries, I'd really suggest reading everything on the link below.
...............................

"This dental malpractice case arises from the bilateral severance of appellee Kirsten Husak's lingual nerve during a procedure to remove her third molars. (1) Appellant Charles Leonard Dolce, D.D.S., M.S., performed the procedure. Husak brought suit alleging negligence against Dr. Dolce and his employer, appellant Austin Periodontal Associates, Inc. f/k/a C. Leonard Dolce, D.D.S., M.S., Inc. (2)

After an eight-day jury trial, the jury found Dr. Dolce negligent and awarded Husak damages. The trial court rendered judgment on the verdict. In five issues, appellants contend that the trial court's judgment should be reversed and that they should be granted a new trial. For the reasons that follow, we overrule their issues and affirm the judgment."
...............

The trial court submitted a broad form negligence question to the jury--"Did the negligence, if any, of C. Leonard Dolce, D.D.S., M.S., proximately cause the injury in question?" The jury answered, "Yes."

The jury awarded the following amounts in response to the damages question: (i) $45,879.75 for medical care expenses in the past; (ii) $50,000 for physical pain and mental anguish sustained in the past; (iii) $200,000 for mental anguish that, in reasonable probability, Husak will sustain in the future; (iv) $19,500 for physical impairment sustained in the past; (v) $150,000 for physical impairment that, in reasonable probability, Husak will sustain in the future; and (vi) $6,000 for loss of earning capacity sustained in the past. (6)

Based on the verdict and the trial court's ruling as a matter of law that Dr. Dolce was acting within the course and scope of his employment, the trial court entered judgment against appellants for $503,923.59, which included the damages found by the jury plus pre-judgment interest. This appeal followed..........

http://bulk.resource.org/courts.gov/states/Tex.App.03/16488.html


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  Subject     Author     Message Date     ID  
  RE: A Very Interesting Case charlottefr Jul-14-08 1
  RE: A Very Interesting Case stillouthere Jul-24-08 2
     RE: A Very Interesting Case bowho Aug-07-08 3
         RE: A Very Interesting Case Bob Aug-07-08 4
             RE: A Very Interesting Case bowho Aug-07-08 5
             RE: A Very Interesting Case Dr B Aug-07-08 6
                 RE: A Very Interesting Case charlottefr Jan-01-09 7
                     Severed Lingual Nerve charlottefr Jul-21-11 8

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charlottefr
Member since Feb-22-08
508 posts
Jul-14-08, 05:04 AM (CST)
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1. "RE: A Very Interesting Case"
In response to message #0
 
   FACTUAL AND PROCEDURAL BACKGROUND

"Husak's general dentist Tommy Thomson referred Husak to Dr. Dolce to have crown lengthening done on two of her teeth. (3) During the preoperative appointment, Dr. Dolce and Husak discussed and agreed that Dr. Dolce would remove her third molars at the same time.

The surgery took place in April of 2002. During the removal of her third molars, Dr. Dolce bilaterally severed Husak's lingual nerve. He also broke a burr (4) in her mouth and did not inform Husak after the surgery that he was unable to find the broken piece.

From the surgery, Husak suffered infection, dry socket, and total anesthesia of the front two-thirds of her tongue. Dr. Dolce referred Husak to Dr. James Fuselier, an oral surgeon in Austin, for further treatment, including to treat her infection. Dr. Fuselier referred Husak to Dr. Donald Cohen, an oral surgeon in Houston with postsurgical training in oral and maxillofacial surgery. Dr. Cohen attempted microsurgical repair on the left side of Husak's lingual nerve in August and the right side in October, but the repairs were unsuccessful.

Husak sued Austin Periodontal alleging multiple theories of negligence in bilaterally severing her lingual nerve. Husak's theories included that the removal of her third molars was medically unnecessary and that Dr. Dolce negligently removed her third molars by his incisions or, alternatively, by his drilling. Husak alleged that Dr. Dolce's incisions were below the standard of care because they were made in an area of her mouth where the lingual nerve was known to be located and that the incisions caused her injury. (5) Alternatively, Husak alleged that Dr. Dolce improperly drilled into the area of her mouth where the lingual nerve was known to be located and that the drilling was the cause of her injury.

At trial, Husak and her former boyfriend, John McCarthy, testified concerning Husak's physical and mental condition before and after the surgery and the effect the injury has had on her.

Husak also presented expert opinion testimony from Dr. Cohen, Dr. Thomson, and Dr. Robert W. Staley, Jr., D.D.S., an oral and maxillofacial surgeon from Oregon.

Appellants' defensive theory to the jury was that severance of the lingual nerve was an inherent risk of the procedure, that Dr. Dolce's technique was within the standard of care, and that he severed Husak's lingual nerve during the procedure because the nerve was in anatomically aberrant locations on both sides of her mouth. Dr. James T. Mellonig, D.D.S., a periodontist and professor at the University of Texas Health Science Center in San Antonio, testified as appellants' expert"
http://bulk.resource.org/courts.gov/states/Tex.App.03/16488.html


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stillouthere
Member since Jul-24-08
4 posts
Jul-24-08, 02:40 AM (CST)
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2. "RE: A Very Interesting Case"
In response to message #0
 
   On Wednesday, June 25, 2008, the Oregon Court of Appeals affirmed the trial court’s ruling in Franco v Willamette Dental — basically upholding the verdict. The trial was two years ago during the summer of 2006 and involved damage to our client’s lingual nerve from wisdom tooth extraction. The court did not issue an opinion but issued an “AWOP” — affirmed without opinion. The insurance company for the defendant is Fortress Insurance, the dental branch of OMSNIC (the oral surgeon branch). After the verdict the highest offer made from Fortress to our client (over a year and a half after the verdict which runs at 9% interest) was less than half of the jury verdict. Fortunately, our client had the courage to stand up to the company and let the court decide.

This entry was posted on Thursday, June 26th, 2008 at 12:07 pm and is filed under Legal. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.


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bowho
Member since Nov-27-07
1112 posts
Aug-07-08, 00:47 AM (CST)
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3. "RE: A Very Interesting Case"
In response to message #2
 
  

Dentist's Advantage Case Studies

Dental Implant Injuries Inferior Alveolar Nerve - $2.6 Million Verdict.

The plaintiff, age forty-five, went to a defendant doctor in September 2004 for consultation regarding dental implants. A second defendant doctor performed the procedure.

The plaintiff suffered immediate pain after the surgery and soon had the implant removed. The plaintiff claimed that the implant was not properly fitted, in that it was too long and went through her inferior alveolar nerve.

The defendants claimed that there was no negligence and argued that the nerve would regenerate.

According to a published account a $2,623,076 verdict was returned. The doctor who performed the procedure settled for $1.5 million. The other doctor filed an appeal.

With permission from Medical Malpractice Verdicts, Settlements & Experts; Lewis Laska, Editor, 901 Church St., Nashville, TN 37203-3411, 1-800-298-6288.

http://www.dentists-advantage.com/rskmgt/casestudy/getCase.jsp?id=277
Dentist's Advantage Case Study Archives




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Bob
Member since Aug-6-07
389 posts
Aug-07-08, 08:47 PM (CST)
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4. "RE: A Very Interesting Case"
In response to message #3
 
   I wish there were some successful cases regarding injectional injuries. I don't know of any and have been told that my "case" would forge new ground should I choose to pursue it.


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bowho
Member since Nov-27-07
1112 posts
Aug-07-08, 09:38 PM (CST)
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5. "RE: A Very Interesting Case"
In response to message #4
 
   LAST EDITED ON Aug-07-08 AT 09:41 PM (CST)
 
Bob ... Check and see if you were given proper management for your damage... Maybe you can sue for improper management of the injury ?

Management of patients with trigeminal nerve injuries after mandibular implant placement


RICHARD A. KRAUT, D.D.S. and OMAR CHAHAL, D.D.S.


ABSTRACT
TOP
ABSTRACT
PREOPERATIVE PLANNING
INTRAOPERATIVE COMPLICATIONS
EVALUATION AND MANAGEMENT
CONCLUSION

REFERENCES

Background. Placement of mandibular endosseous implants can result in damage to the lingual nerve, the inferior alveolar nerve or both nerves. All dentists who place mandibular implants should be aware of the appropriate early management of these injuries, as well as the appropriate time to refer patients with these injuries to a microneurosurgeon.

Overview. The lingual nerve is less likely to undergo spontaneous regeneration than is the inferior alveolar nerve, which is protected within the inferior alveolar canal. Since the inferior alveolar canal can be seen on most panoramic radiographs and on all high-quality computed tomographic scans, it is easier to avoid damage to the inferior nerve than to the lingual nerve, which is not visualized on radiographs and whose relationship to the posterior portion of the mandible varies from person to person.

Results. The authors reviewed one study that showed that lingual nerve repair helped 90 percent of patients. A second study found that patients who underwent lingual nerve repair reported a mean score of 7 on a scale from 0 to 10 in regard to the postoperative return of nerve function. Several other studies reported favorable patient responses to inferior alveolar nerve repair.

Conclusions and Clinical Implications. These results reinforce the need for early referral and intervention when inferior alveolar nerve injuries occur. Failure to refer patients with trigeminal nerve injury before distal nerve degeneration develops prevents minimization of the injury through microneurosurgical repair.

Placement of mandibular endosseous implants can result in damage to the lingual nerve, the inferior alveolar nerve or both nerves.1–6 The risk of nerve injury depends on multiple factors, including administration of inferior alveolar nerve block,7–12 the difficulty of the proposed procedure and the surgeon’s level of expertise. Inferior alveolar nerve lateralization and posterior alveolar distraction are high-risk procedures that are more likely to result in inferior alveolar nerve defect regardless of the surgeon’s experience; these procedures are further complicated if the patient has extremely dense bone.13

These results reinforce the need for early referral and intervention when inferior alveolar nerve injuries occur.

When the lingual or inferior alveolar nerve is injured, it is imperative that the surgeon recognize the injury and treat the patient appropriately. The purpose of this article is to examine ways to avoid, diagnose and manage nerve injuries associated with placement of mandibular endosseous implants.


PREOPERATIVE PLANNING
TOP
ABSTRACT
PREOPERATIVE PLANNING
INTRAOPERATIVE COMPLICATIONS
EVALUATION AND MANAGEMENT
CONCLUSION
REFERENCES

Altered sensation after mandibular implant placement is the result of trauma to any of the branches of the mandibular nerve, including the inferior alveolar, mental and lingual nerves.6,12–14 It is important for clinicians to perform a neurosensory examination of mandibular nerve function before placing the implant to determine whether there is pre-existing altered sensation. Great care must be taken when selecting possible sites for implant placement. Appropriate radiographic evaluation of the implant site is indicated.

When selecting implants based on preoperative panoramic images, clinicians must make sure that a marker of known dimension has been imaged in the area being considered for implant placement.6 We recommend a safety margin of 2 millimeters between the end of the implant and the canal when selecting the length of implants that are to be placed above the inferior alveolar canal (Figure 1Go). Because of its greater precision, computed tomography enables the clinician to select an implant that will be 1 mm above the canal.6 Implant burs vary depending on the manufacturer and must be understood by the surgeon because the specified length (for example, a 10-mm marking) may not reflect an additional millimeter included for drilling efficiency.

View larger version (113K):


Figure 1. Panoramic radiograph with marking balls of known dimension in the area of the planned implants. The inferior alveolar canal has been marked to facilitate measurement of the space above the canal to determine the length of implants to be placed.


When placing implants in proximity to the mental foramen, the clinician must take into consideration the anterior loop of the nerve (Figure 2Go), as well as the available bone above the mental foramen, because the inferior alveolar nerve often rises as it approaches the mental foramen (compared with its height in the molar region) (Figure 3Go).

View larger version (90K):


Figure 2. The mental nerve exits via a broad foramen, as seen in cross-sections 38 through 41; however, an anterior loop of the nerve appears in cross-sections 42 through 46. It is impossible to determine from the computed tomographic scan whether the radiolucency seen is an anterior loop of the mental nerve or an unusually large incisive nerve.


View larger version (95K):


Figure 3. The inferior alveolar nerve often rises as it approaches the mental foramina. This is clearly evident on the panoramic view in areas 35 through 45 and 95 through 87.

INTRAOPERATIVE COMPLICATIONS
TOP
ABSTRACT
PREOPERATIVE PLANNING
INTRAOPERATIVE COMPLICATIONS
EVALUATION AND MANAGEMENT
CONCLUSION
REFERENCES

Nerve damage after administration of an inferior alveolar nerve block is a documented, but very rare, intraoperative complication.7–12 Both the lingual and mental nerves are at risk during elevation of the mandibular mucoperiosteum.15 Careful flap design and elevation are important to avoid nerve injury while working on the buccal surface of the mandible in the region of the mental foramen or posterior mandible. The mental foramen may be located at or near the crest of an atrophic mandible (Figure 4Go). To avoid damage to the mental nerve in patients with atrophic mandibles, the clinician may need to make incisions in the area of the mental foramen that are lingual to the crest of the mandible.

View larger version (86K):


Figure 4. A. The nerve exits at the crest of the ridge in cross-sections 40 and 41. The incision must be on the lingual aspect of the mandible to avoid transecting the mental nerve when the symphysis is exposed at the time of implant placement and at the time of healing cap placement. B. Atrophic mandible in which the mental foramina are close to the crest of the ridge. The incision for implant placement must be on the lingual aspect of the crest to avoid transecting the mental nerves.


The lingual nerve in the molar region typically is in close proximity to the lingual plate below the crest of the ridge. Anatomic dissections have demonstrated variation in the position of the lingual nerve. In a magnetic resonance study, Miloro and colleagues15 found that the nerve actually coursed over the retromolar pad in 10 percent of patients. In these cases, the nerve may be traumatized by flap elevation and retraction or during suturing.15 In addition, the lingual nerve may be damaged by direct implant encroachment.


EVALUATION AND MANAGEMENT
TOP
ABSTRACT
PREOPERATIVE PLANNING
INTRAOPERATIVE COMPLICATIONS
EVALUATION AND MANAGEMENT
CONCLUSION
REFERENCES

The most desirable outcome after nerve injury is spontaneous return of normal sensation. The likelihood of this occurring depends on both the severity of the injury and the nerve involved. Partial transection of the lingual nerve is less likely to result in spontaneous resolution of symptoms than is a similar injury involving the inferior alveolar nerve, which has a bony canal to contain and direct the regeneration fibers.

Lingual nerve injury. Clinicians should document any unusual response (such as unusual pain or an electrical shock–like feeling) during administration of local anesthetic or during surgery. If a nerve injury is suspected, he or she should perform thorough, standardized tests to document the level of neurosensory function as soon as an injury is suspected (usually the day after surgery). The clinician should outline the area of decreased sensation on the patient’s tongue, record this area in the patient’s medical record and preferably photograph the tongue. The clinician should describe and document the nature of the altered sensation, as described by the patient (including duration, inducing factors, hyperesthesia, dysesthesia, anesthesia and loss of sense of taste with the use of salt and sugar).

The clinician should repeat the neurosensory examination and compare the results with the baseline examination results no later than one month after surgery. Total anesthesia or the development of hyperalgesia or spontaneous pain are predictors of poor response without surgical intervention, and should lead clinicians to make prompt referrals to a microneurosurgeon no later than one month after surgery. Signs of diminishing sensation or failure of sensation to improve on repeated testing also are indicators that normal sensation will not likely return spontaneously.

If a patient’s condition fails to show improvement or neurosensory function has deteriorated two months after the nerve injury occurred, the surgeon should promptly refer him or her to a microneurosurgeon. The microneurosurgeon often will want to perform his or her own neurosensory examination and may wish to repeat the examination one month later to avoid surgery in the case of a resolving injury. The goal of early referral is to allow the patient to undergo nerve repair within four months of the injury, thereby minimizing distal degeneration of the nerve.12

Robinson and colleagues16 studied 53 patients who underwent lingual nerve repair. They reported that patients generally considered the operation to be worthwhile, as indicated by a mean score of 7 on a scale from 0 (no change) to 10 (normal nerve function). Zuniga and colleagues17 conducted a study in which 90 percent of patients reported having experienced regeneration of fungiform taste receptors and recovered taste after undergoing lingual nerve repair; patients also expressed global satisfaction relative to the repair, as indicated by a mean score of 2.5 on a scale from 0 to 4. Although both of these studies reported excellent results, they clearly indicate variable responses and reflect the need for patients to have realistic expectations when they elect to undergo lingual nerve repair.

Inferior alveolar nerve injury. As with lingual nerve injuries, clinicians should document unusual patient reactions occurring during surgery (such as sharp pain or an electrical shock–like sensation). If a nerve injury is suspected, the clinician should perform a thorough neurosensory examination and document the results the day after surgery (when the effects of the anesthetic should have worn off). The clinician also should record the patient’s subjective assessment of altered sensation. He or she should document nerve function by lightly touching the lip and chin with a wisp of cotton at the end of a cotton swab to determine sensitivity.

Use a soft brush to assess the patient’s ability to determine the direction of movement on the lip and chin (with the patient’s eyes closed), perform a 27-gauge needle test to determine the patient’s ability to perceive pain, and determine two-point discrimination on the lip and chin using a pointed caliper that is gradually opened to a distance of 1 centimeter. The final aspect of the neurosensory examination consists of temperature sensitivity testing on both the affected lip and part of chin and unaffected lip and part of chin. The clinician uses ice and a mirror handle warmed to 43 C to determine if the patient feels cold or heat.

The clinician should map any area of neurosensory deficit and photograph it to compare with future photographs. If an implant is potentially violating the canal, its depth should be decreased in bone (by unscrewing it a few turns) and left short of the canal or removed. Since the altered sensation may be due to an inflammatory reaction, a course of steroid treatment or a high dose of nonsteroidal anti-inflammatory medication (such as ibuprofen three times per day) should be prescribed for three weeks.

If improvement is noted at three weeks on the basis of a repeated neurosensory examination, the clinician can prescribe an additional three weeks of anti-inflammatory drug treatment. If, however, sensation has not improved by two months, the prognosis typically is poor, and we recommend referral to a microneurosurgeon. If the clinician notes improvement at two months, he or she should re-examine the patient at three and four months after the injury occurred. If the patient’s nerve function has not returned to the baseline level by four months, we recommend referral to a microneurosurgeon.

As early as 1985, Mozsary and Syers18 discussed guidelines for microsurgical reconstructive procedures in the treatment of inferior alveolar nerve injuries. Ruggiero,12 LaBanc and Van Boven,19 Colin and Donoff20 and Pogrel and Maghen21 reported favorable patient responses to inferior alveolar nerve repair, and all emphasized the need for repair before Wallerian degeneration of the distal portion of the inferior alveolar nerve has occurred (since this degeneration is a slow process, repair is possible four to six months after the injury has occurred).


CONCLUSION
TOP
ABSTRACT
PREOPERATIVE PLANNING
INTRAOPERATIVE COMPLICATIONS
EVALUATION AND MANAGEMENT
CONCLUSION
REFERENCES

Although uncommon, peripheral trigeminal nerve injury can occur after placement of mandibular implants. Practitioners who place implants must discuss the possibility of nerve injury with their patients and include this possibility in the consent forms. If nerve injury occurs or is suspected after the procedure, the clinician must inform the patient of its existence and make a timely referral to an appropriately trained microneurosurgeon if necessary.12,17–21

http://jada.ada.org/cgi/content/full/133/10/1351
Management of patients with trigeminal nerve injuries after mandibular implant placement -- KRAUT and CHAHAL 133 (10): 1351 -- The Journal of the American Dental Association


Here is more for you to check out ....

http://www.webcrawler.com/webcrawler301/ws/results/Web/malpractice%20cases/1/0/0/Relevance/zoom=off/qi=1/qk=20/bepersistence=true/_iceUrlFlag=7?_IceUrl=true
malpractice cases - Web - WebCrawler

http://www.wrongdiagnosis.com/medical-malpractice/statistics_about_medical_malpractice_cases.htm
Statistics about medical malpractice cases - WrongDiagnosis.com

http://www.fagellaw.com/
California Medical Malpractice Attorney - California Medical Malpractice Lawyer


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Dr B
Member since Oct-6-06
975 posts
Aug-07-08, 11:02 PM (CST)
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6. "RE: A Very Interesting Case"
In response to message #4
 
   It is hard to win an injectional injury by jury but sometimes they are settled favorably. I've been involoved in a few. However, the parties are sometimes made to sign non-disclosures so no one knows what the final settlements were.

Dr B


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charlottefr
Member since Feb-22-08
508 posts
Jan-01-09, 09:28 AM (CST)
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7. "RE: A Very Interesting Case"
In response to message #6
 
   A successful lawsuit involving bilateral lingual nerve damage during wisdom tooth extraction

http://www.countycourt.vic.gov.au/CA256D90000479B3/Lookup/Judgments_A/$file/akbulut.pdf


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charlottefr
Member since Feb-22-08
508 posts
Jul-21-11, 02:32 PM (CST)
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8. "Severed Lingual Nerve"
In response to message #7
 
   LAST EDITED ON Jul-21-11 AT 02:38 PM (CST)
 
This is very interesting to read...check out leagle.com to read it all.

CORINO v. GOLDMAN

Decided July 8, 2011.

"In this dental malpractice case, defendant Elliot H. Goldman, D.D.S., appeals from a judgment entered October 6, 2009, awarding plaintiff Anthony J. Corino damages with prejudgment interest in the total amount of $138,669.50 and a subsequent order denying his motion for a new trial. After reviewing the record in light of the applicable law, we affirm."

……………………………….............

“According to Marged, the lingual nerve was outside the "field of surgery" during plaintiff's operation, so there was no need for defendant to "go anywhere near" it. He further stated: "I believe based on all the records that I reviewed, and all the deposition transcripts, and pictures that I saw from Dr. Ziccardi, that did deviate from the accepted standards of care by cutting that lingual nerve. That should never have happened."


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