A dental surgeon transgressed a vital "no-go" nerve barrier zone while carrying out a bone graft under the teeth line of a patient's chin, a High Court judge has held.
The ruling was handed down yesterday by Mr Justice Kearns in the second part of a three-tier decision-making process adopted by the court in a medical negligence action for damages.
Mr Peter Geoghegan, head of Associates Rewinds (Ireland) Ltd, formerly of Rathfarnham, Dublin, and now living at Straffan, Co Kildare, is suing Mr David Harris, a specialist facial surgeon, who has a practice at the Blackrock Clinic, Co Dublin.
Mr Justice Kearns said the factual issue upon which Mr Geoghegan had based his allegation of medical negligence had been whether or not Mr Harris had transgressed a 5 mm barrier zone between the gum line of Geoghegan's lower frontal incisor teeth and the upper margin of the bone graft. Mr Geoghegan alleged severe pain following the dental procedure eight years ago.
He had been referred to Mr Harris to find out if he could have four implants in his jaw. Mr Harris had told him there was insufficient bone in relation to one implant and that a small bone graft would be necessary. The operation had taken place under general anaesthetic on July 1st, 1992, and five days later Mr Geoghegan, "in awful pain", had visited the surgeon.
Mr Justice Kearns said Mr Harris had accepted that if he had transgressed the "no-go" zone he would have been in error, but he had not accepted, nor did he believe, that he had done so.
The court had concluded that at all times subsequent to July 6th Mr Harris believed he had transgressed the zone and his behaviour from that time onwards had corroborated that view.
The court did not accept that Mr Harris had told Mr Geoghegan of his suspicions, as otherwise it would have been quite inconceivable that Mr Geoghegan's originating letter of complaint six weeks later would not have referred to such an admission of error. Nor would it have been necessary for Mr Geoghegan to have undertaken inquiries to try to ascertain the cause of pain.
Mr Justice Kearns held that the inferences from the only anatomical evidence in the case supported the proposition that the bone cuts, or one of them, had been within the "no-go" zone.
In the first tier of his judgment, Mr Justice Kearns found against Mr Geoghegan on the basis that he would not have been deterred from undergoing the procedure even if a warning had been given to him of the remote possibility of chronic neuropathic pain occurring as a result of nerve damage during the bone graft procedure.