Management of Lip Paraesthesia post Root Canal Treatment via Unilateral Sagittal Split Osteotomy: Case report.

This case report discusses a rare and severe complication arising from endodontic treatment, specifically overfilling and extrusion of root canal sealer into the mandibular canal, leading to injury of the Inferior Alveolar Nerve (IAN). A 42-year-old female presented with severe pain and complete paraesthesia in the lower lip and chin area ten (10)days after endodontic treatment. Radiographic examinations revealed left overfilled root canals extending approximately five (5) centimetres along the mandibular canal. A unilateral sagittal split osteotomy was performed using piezosurgery to protect the nerve. Meticulous dissection was performed to release it from the canal. Notably, rigid paste debris was observed in proximity to and within the nerve canal. The nerve exhibited signs of swelling and was enveloped by granulation tissue. A thorough cleaning procedure ensued, followed by the repositioning of the two mandibular cortices, securing them in place with AO 5.0-mm diameter bicortical screws. Orthodontic brackets were used to stabilize the occlusion for six (6) weeks. Two weeks after the surgery, the patient reported that the pain had significantly improved, with only a tingling sensation remaining. The feeling of pressure was completely relieved. At one year follow-up, the sensation was partially restored and no pain was reported. This case underscores the potential for serious complications arising from endodontic treatments and highlights the efficacy of surgical exploration, particularly through sagittal osteotomy, in addressing nerve injuries caused by overfilled root canals.