Outcomes, interventions and timing in permanent lingual nerve injury: a systematic review with meta-analysis and workflow proposal

PURPOSE: Lingual nerve injury (LNI) is a frequent complication of oral and maxillofacial surgical procedures. This systematic review and meta-analysis aimed to synthesize current evidence on the epidemiology, management strategies, and outcomes of LNI. METHODS: Following PRISMA guidelines, PubMed/MEDLINE, Cochrane Library, Scopus, and Google Scholar were searched for observational studies and clinical trials reporting LNI. Outcomes included etiology of permanent LNI, interventions, timing of repair, and functional sensory recovery (FSR). A single-arm random-effects meta-analysis was performed. Bias was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2. RESULTS: Twenty-eight studies involving 1358 permanent LNI were analyzed. Molar extraction was the leading cause (1102/1176; 95%CI: 98-100%). Median time from injury to repair was 7.7 months (95%CI: 6.5-15.8). Pooled FSR rate after intervention was 92% (837/910; 95%CI: 87-96), with median time to recovery of 7.2 months (95%CI: 3.7-9.6). No significant difference was observed between repairs performed before or after 6 months. CONCLUSIONS: LNI is a complication of oral and maxillofacial surgery, with molar extraction representing the leading etiology. Permanent neurosensory deficits may occur, but microsurgical repair provides favorable outcomes, especially within the first year. Standardized outcome reporting is recommended to guide surgical decisions and improve patient care. A schematic management guideline is proposed based on current evidence.