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A Journal on Forensic Medicine
Minerva Medicolegale 2005 December;125(4):245-9
Medical-legal evaluation in cases of uncertain interpretation in the field of odontology. Case report
Lanzara G., Zaglia E., Dolci M., Calcagni C.
In our country judicial proceedings involving odontologists are very frequent and sometimes the accusations from the patients are false and focused on unreliable clinical symptoms. We discuss a case of suspected iatrogenic lesion of the inferior alveolar nerve (third trigeminal branch). The patient, after an intervention of oral surgery (implant-prosthetic intervention), was observed at our Division of Odontology since she was complaining about anesthetic and paresthetic symptoms localized in the same area submitted to surgery 6 months before. The instrumental and radiological examinations performed in order to identify the anatomic neurological impairment, showed a contradiction between the symptoms complained by the patient and the real anatomic and neurological conformation. For that reason we supposed a simulation aimed at obtaining an indemnity for damage. Focusing our attention on the frequent disposition of the patients to modify the symptomatology, in this paper we suggest standardized tools and specific flow-charts to correctly differentiate real symptoms from simulation. This is a common approach in the field of legal medicine. Despite the wide anatomic variability between different people, in our opinion standardized flow-charts and protocols are user-friendly, do not require subspecialty qualifications and are very useful for methodologically correct disclosure of simulation attempts.