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Oral Surgery/Lower lip nerves and teeth affected by block bone graft


QUESTION: Hello Dr. Ryan,

I had a block bone graft performed where my chin was used as a donor site for my upper jaw.  It has been a year and a half and the nerve sensitivity has not significantly gotten better, although the movement has improved.  There are several things going on:  the lower lip still feels tingly and actually cool as if I have cold water running on it constantly.  When I touch the top of my lower front teeth, #26 - #23, electric shocks shoot up through my entire lower lip and when I touch at the roots of the teeth, next to the gum line, the shocks intensify dramatically.  The movement has improved, but when I pucker, it feels like it is stuck at the chin (where the bottom lip attaches to the gums at chin is not flexible, if that makes any sense) and I'm always "aware" of it, for example, it's almost like I have a hair tickling on my lower lip and I'm constantly trying to pull if off but there is nothing there.  There is some numbness at the center base of my lip.  My question is, when and will this nerve sensation finally go away?

Thank you for your time.

ANSWER: Tom, Thank you for your question. Unfortunately, it is extremely difficult to predict the answer for your question. The reason is because it depends on many factors. 1) was the nerve damaged at the time of surgery? - if so what level of damage. 2) your age will also help to predict the nerve recovery if there is no damage to the nerve - the older you are (>35) the less likely and more time it will take for the nerve to recover. The nerve that is affected is the incisive branch of the trigeminal nerve. Usually this nerve is traumatized when performing a bone graft from the chin area. Personally, I do not harvest bone from the chin area anymore because of the issues that you are dealing with and there are many more options that don't carry the morbidity that the chin harvesting does. The current thought is that after about a year of recovery is all that you can expect, however, there are cases that the nerve does and can recover for about 2 years after surgery...unless it was cut. I hope that helps.

---------- FOLLOW-UP ----------

QUESTION: H Dr. Ryan, The nerve was affected immediately following the surgery.  I could hardly move my lower lip for months and it finally increasingly gained mobility after 6 months but it wasn't until a year that I could pucker it.  Im in my mid 40's.  I feel as if you are telling me that the electric shocks, sensitive teeth nerves, and tingly sensation, etc... is something that I might have to just live with the rest of my life?  I will be hopeful it will get better but it's not sounding like it might?  How do I know if it was cut?

Thank You,

Tom, you are describing two different issue. The ability to move your lip and the feeling are different issues. The motor nerve for the lip movement are not in the bone and the nerve that gives you feeling are in the bone. As for the electric shocks, sensitive teeth, and tingling, I am unable to give you advice on weather that will go away because I would need to examine you. To tell if if was cut, you can see an oral and maxillofacial surgeon in their office and they will examine you with a radiograph to tell you if they think it was cut or not.  

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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