Medicolegal considerations involving iatrogenic lingual nerve damage

The aim of this review is to improve risk management strategies through analysis of the anatomic, semeiotic, and medicolegal aspects that characterize iatrogenic lingual nerve damage (LND) and its legal consequences in the case of legal proceedings for a claim for compensation. In dental practice, LND can be caused by local or general anesthesia or by mechanical, chemical, or thermal mechanisms. A certain postoperative identification of LND etiopathogenesis is often very challenging because it can be difficult to show at what time the damage occurred and which mechanism actually caused it. Clinical tests assessing lingual nerve sensory capabilities have a low sensitivity and moderate specificity, whereas instrumental tests have the advantage of not being affected by data interpretation subjectivity by both the operator and the patient. The quantification of permanent LND is not uniformly established, and there are no specific standard worldwide indications. From a medicolegal point of view, LND is a complication that may or may not be caused by surgical error. The 2 different concepts of “expectability” and avoidability or preventability allow one to discriminate between professional liability and fate and therefore to determine the surgeon's imputability in LND. Despite clinical competence and practice in performing the medical or surgical procedure, the clinician risks a lawsuit for negligence if he or she does not warn the patient about all relevant risks regardless of their frequency. Informed consent plays an essential role in minimizing litigation; the patient must be informed—with both his or her level of culture and ability to understand being taken into consideration—of the diagnosis, prognosis, and therapeutic perspectives and their consequences, in addition to all other viable alternative therapies, as well as the risks of nontreatment.