## 3 Results  
In total, 453 lower third molars from 305 patients were extracted. The age of patients ranged from 18 to 45 years with a mean of 31.5 years. Among the 305 patients, 200 (65.6%) were men and the remaining 105 patients (34.4%) were women (Table 1). Three hundred surgical sites (66.2%) were on the right side while 153 (33.8%) surgical procedures were performed on the left side. In total, 185 teeth (40.9%) were partially erupted, and the remaining 268 (59.1%) were fully covered (Table 2). Regarding the angulation of the impacted lower third molars, the most common pattern of impaction was mesoangular (36.8%). The aberrant patterns of impactions were the least common, being present in only twenty cases (4.4%), eight of which were lingually angulated while the remaining twelve cases were horizontal and buccally tilted (Table 1). All lower third molars included in this study required reflection of a buccal flap and buccal bone removal, and possibly distal bone removal. Tooth division was required in almost half of the cases (78.4%) (Table 1). The majority of the impacted teeth (84.5%) were in position A or B according to [PERSON]'s classification. Figure 4: Inclination of the retractor in the final position in the lingual area. anesthesia employed, stage of eruption, and angulation and depth of the lower third molar, as well as the proficiency of the operator [29; 30]. Thorough knowledge of lingual nerve anatomy and topography is crucial to avoid iatrogenic nerve damage or at least to lower the risk of nerve injury. According to [PERSON] et al., lingual nerve spatial localization ranges widely from individual to individual, as well as in the same individual, in areas from the third molar region to the submandibular gland [31]. The concept of normalcy in anatomy is considered relative. Understanding anatomical variables is crucial not only for addressing diagnostic challenges but also for developing surgical procedures [32]. According to [PERSON]'s metanalysis, the LN was found to be locate below the lingual/alveolar crest in 77.87% of cases, above the lingual/alveolar crest in 8.21% of cases, and in direct contact with the lingual plate in 37.61% of examined nerves [33]. Injuries to the lingual nerve during surgical procedures involving the third molar region necessitate a thorough investigation of its typical course and notable variations. Reports indicate a varied incidence (ranging from 0 to 62%) of direct contact between the lingual nerve and the alveolar wall of the third molar [33; 34; 35; 36; 37; 38]. It commonly travels on the periosteum on the medial surface of the mandible and finds itself opposite the posterior root of the lower third molar. At this location, it is covered solely by the gingival mucoperiosteum and is bound closely to the lingual plate of the mandible. This anatomical course can also be observed clinically, in those cases in which an accidental location of the periosteum occurs during incorrect management of the lingual flap (Figure 5). The lingual periosteal laceration does not directly harm the lingual nerve but poses an indirect risk because it hampers the possibility of complete detachment of soft tissues from the lingual mandibular plate. Some studies suggest that the prevention of LNI through the detachment of the lingual flap is essential to avoid the harmful action of rotary instruments on the lingual soft tissues that may occur during odontomy or osteotomy [29]. In our study, 453 surgical extractions of impacted third molars were performed using the surgical technique involving lingual flap retraction (LF+). None of the cases reported post-surgical permanent lingual nerve injury; there was zero incidence of lingual nerve paresthesia or dysesthesia. However, there are contrasting opinions in the literature. Among the proponents of the LF technique, several authors stand out, but the most significant study was conducted by [PERSON] and [PERSON] in 1996. They suggested that the LF technique comes with a lower incidence of LNI compared with the LF+ technique [38].