ORIGINAL ARTICLE Surgical treatment of painful inferior alveolar nerve injuries following endodontic treatment: a consecutive case series of seven patients Federico Biglioli 1 & Otilija Kutanovaite 2 & Luca Autelitano 1 & Alessandro Lozza 3 & Laura Moneghini 4 & Gaetano Bulfamante 4 & Fabiana Allevi 1 Received: 22 March 2017 /Accepted: 14 September 2017 # Springer-Verlag GmbH Germany 2017 Abstract Purpose Injuries of the inferior alveolar nerve (IAN) related to endodontic treatment are being increasingly reported. However, consensus on the preferred intervention and the timing of and indications for surgical treatment is lacking. Here, we describe our experience with painful IAN injuries arising from endodontic treatment and requiring prompt mi- crosurgical treatment. Methods Seven consecutive patients with painful IAN inju- ries were referred to the Maxillofacial Surgery Unit of San Paolo Hospital in Milan. All patients had undergone root ca- nals endodontic treatment in the mandibular molar or premo- lar between 2007 and 2014. The time elapsed between injury and referral for surgical treatment ranged from 10 days to 20 months. Each patient was treated by one of several differ- ent microsurgical procedures, described herein. Results Overall, neurosensory status and IAN-related pain improved in all seven patients. The best results were obtained by IAN replacement with a sural nerve graft. However, com- plete sensory recovery was not achieved in any of the patients. Conclusions Although our sample includes only seven pa- tients, early surgical treatment with an interpositional sural nerve graft seems to allow neurosensory recovery. Less satis- factory results are achieved in patients with IAN injuries of > 12 months duration. Keywords Inferior alveolar nerve . Endodontic treatment . Microsurgical repair . Lip pain Introduction Inferior alveolar nerve (IAN) injury can be caused by trauma, infection, neoplasm, and oral and maxillofacial surgical pro- cedures, but it is also often caused by endodontic treatment [1]. Because most cases of endodontic-related IAN injury are not reported, the true prevalence and incidence have probably been underestimated [2–4]. Altered sensation subsequent to endodontic treatment varies greatly and may manifest as hypoaesthesia, paraesthe- sia, or anaesthesia, with or without pain or dysaesthesia. The degree of sensory nerve impairment is related to the severity of the nerve injury. Although surgical, medical, and psycho- logical techniques have been used to treat patients with IAN injuries, consensus on the preferred intervention and the timing of and indications for treatment is lacking [1, 5]. However, in the case of painful endodontic-related IAN inju- ry, immediate surgical treatment is warranted. Here, we describe our experience with painful IAN injuries associated with endodontic treatment and requiring prompt surgical treatment. Our retrospective review was based on a small case series of seven consecutive patients with painful IAN injuries who were referred to the Maxillofacial Surgery Unit of San Paolo Hospital in Milan. All patients had under- gone root canal treatment of a mandibular molar or premolar * Fabiana Allevi fabiana.allevi@gmail.com 1 Maxillofacial Surgical Unit, San Paolo Hospital, Department of Health Sciences, University of Milan, Via di Rudini’ 8, 20142 Milan, Italy 2 Maxillofacial Surgery Department, Vilnius University Hospital Zalgiris Clinics, Vilnius, Lithuania 3 Neurophysiopathology Service, C. Mondino National Neurological Institute, Pavia, Italy 4 Unit of Pathology, Department of Health Sciences, San Paolo Hospital, Scienze della Salute Department, University of Milan, Milan, Italy Oral Maxillofac Surg DOI 10.1007/s10006-017-0656-8