A Case Report: Treatment for Lingual Nerve Paralysis Following a Mandibular Third Molar Extraction

Case Summary: A 41-year-old male presented with tingling and numbness along the left lingual border following the extraction of the left mandibular wisdom tooth by another dentist. He was referred to our department because his symptoms persisted despite oral vitamin B12. Upon evaluation, he was diagnosed with left-sided lingual nerve palsy and left-sided lingual neuropathy. Treatment included vitamin B12 supplementation, pregabalin, Kampo medicine, near-infrared therapy, and electroacupuncture. After 1 year and 5 months, tongue-tingling and numbness improved, and taste threshold on the left side was reduced. <br>Discussion: The combined approach, including medication, electroacupuncture, and near-infrared therapy, effectively addressed lingual nerve palsy. The use of pregabalin as the primary treatment for neuropathy, along with Kampo medicine, showed efficacy and helped mitigate pregabalin’s side effects, which can be valuable in neuropathy management. Electroacupuncture effectively alleviated pain, enhanced perception threshold, and reduced subjective abnormal sensations. Acupuncture and electrical stimulation might have improved nerve blood flow and enhanced peripheral nerve regeneration. Near-infrared therapy has analgesic effects by enhancing blood circulation and dampening nerve excitability. In the present case, these therapeutic modalities may be an indirect approach to managing lingual nerve palsy. <br>Conclusion: A comprehensive treatment strategy for lingual nerve palsy encompassing both pharmacotherapy and physiotherapy interventions （acupuncture and near-infrared therapy） can yield favorable results, highlighting the benefits of combining various therapeutic modalities for lingual nerve palsy management.