The lingual nerve provides general sensation (touch, pain, temperature) to the anterior two-thirds of the tongue and floor of the mouth, complemented by the taste fibres it receives from the chorda tympani. Its medial position adjacent to the lower third molar makes it the nerve most commonly injured during wisdom tooth extraction, producing tongue numbness and paraesthesia that can profoundly affect eating and speech quality.
| Origin | Posterior trunk of the mandibular nerve (V3) in the infratemporal fossa |
|---|---|
| Course | Descends between the ramus of the mandible and medial pterygoid, receives the chorda tympani, lies against the mandible just below and behind the lower third molar, then crosses the submandibular duct by passing lateral to it, below it and then medial to it before entering the tongue |
| Motor |
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| Sensory |
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Lingual nerve injury during lower third molar extraction produces ipsilateral anterior tongue numbness and altered taste that is usually temporary but permanent in a small minority when the nerve is cut. The risk is highest with lingually placed teeth and instruments used on the lingual side, because the nerve can lie at or above the lingual bone crest. In the submandibular region the nerve loops around the submandibular duct and is attached to the submandibular ganglion, so it must be identified and protected during submandibular gland excision and duct surgery. Microsurgical repair is offered for complete transections recognised early.
Tongue numbness and altered taste after lower third molar extraction usually recover, but transection may be permanent and is best repaired microsurgically within a few months.
The nerve hooks around the submandibular duct and is pulled down toward the gland, so it can be divided when the gland or duct is removed, causing permanent ipsilateral tongue numbness and taste loss.
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