Ellie Rosenfeld, DDS, MD, FACS

Ellie Rosenfeld, DDS, MD, FACS Board Certified Oral and Maxillofacial Surgeon

08/06/2026

The lingual nerve is closer than you think!

In the lower third molar region, the lingual nerve is usually below the alveolar crest, but “usually” is not the same as always.

Cadaver studies (different studies, hence the ranges of data) have found the nerve at or even ABOVE the alveolar crest in approximately 8% and up to 18% of specimens. And horizontally, it may lie directly against the lingual cortical plate.

That means in some patients, the only thing separating your surgical field from the lingual nerve is a very thin piece of lingual cortex.

A few anatomic numbers worth remembering:

• ~77% of lingual nerves are below the alveolar crest

• Mean position near the third molar: ~3 mm apical to the osseous crest and ~2 mm medial to the lingual plate

• 8–18% have been found at or above the crest

• Direct contact with the lingual cortical plate has been reported in a substantial percentage of specimens

• As the alveolar ridge atrophies, the nerve-to-crest distance can decrease

This anatomy is why I don’t touch the lingual tissue during third molar surgery. When possible, minimize unnecessary lingual manipulation and let tooth sectioning do the work rather than chasing access with increasingly aggressive bone removal. Extraction is totally possible via completely buccal approach.

You can’t see the lingual nerve.

But you should always know where it might be hiding.

DentalAnatomy Dentistry DentalSurgery

07/30/2026

This is beyond. If it’s not criminal, it’s morally depraved.

Help me fight this horror show by sharing this video.

07/16/2026

Seems like as patients become more exposed to information overload online, I have to explain and justify wisdom teeth removal. It’s no problem, because we have studies to justify it. And of course the procedure is authorized by insurance because it’s considered medically necessary, duh.

And yet, patients seem to need very little convincing that they have jaw cavitations and drop thousands to have these nonexistent things fixed with treatments that are of course NOT covered by any insurance. Why are they not covered if they are proven to work? It’s a mystery.

I wonder what the medical codes are for cavitation treatment? Short answer: There is no specific CDT or ICD-10 code for “jaw cavitation” or “NICO (neuralgia-inducing cavitational osteonecrosis).” The diagnosis is not recognized as a distinct billable entity in ICD-10-CM, and there is no CDT procedure code specifically for “cavitation surgery.”

07/08/2026

The tooth needed to come out for orthodontic purposes. At age 10, this extraction is significantly easier than at age 20.

Sulcular palatal incision from basically canine to canine, full thickness flap. I was able to spare the nasopalatine neurovascular bundle.

The palatal bone was too thick to just poke into it, so had to use the hand piece. Sectioning teeth works for when you have access to the wider part of the tooth. In this case, the widest part of the tooth, the crown, is farthest away buried in the deepest bone. So sectioning the tooth was not going to afford me any kind of physical advantage. The goal was simply to remove enough palatal bone so that I could grab the tooth and pull it out.

Elevating can also be a little dicey because of the proximity to the roots of the central incisor, as well as the curvature of the tooth, almost wrapped around the central. The tooth came out easily once the palatal wall of bone was removed.

Flap closed with interdental mattress sutures.

07/03/2026

Some visual OMFS ASMR I filmed of my Bien Air at 50,000 RPM on my macro lens. Not AI. Have a happy and safe July 4th weekend!!! 🇺🇸

07/02/2026

I don’t mind the holistic stuff in theory. If people are buying it, you can provide it. I don’t believe in any of it, but as long as you do it honestly, we can be friends.

However, I take major offense to many of the claims made in this video that mainstream, science-based medicine is getting it WRONG. Some of the implications made in this video that I find problematic:

1. We “trick” patients into removing their wisdom teeth to make money.

2. Prophylactic removal of wisdom teeth should only be done if patients are symptomatic.

3. Implying that we take the wisdom teeth out to use the stem cells inside them.

4. Saying that anyone who removed wisdom teeth without using ozone and lasers has done a bad job and only biological dentists can do it correctly.

5. Implying that any and all symptoms (fatigue, brain fog, immune disorders, and she says “any other symptoms) can be attributed to wisdom tooth removal.

The layers and layers of garbage in this video are just mind blowing. Help me fight it by sharing this video.

06/25/2026

Not kidding even a little.

Anyone else with me?? I mark up the X-rays with a color coded legend and then I count the Ike 2-3 times. And I’m still constantly stressed about it.

06/18/2026

How is traffic still a valid excuse?? I will never understand. How do they think my staff and I got to the office?! Do they think we teleported? Or that we live here? Traffic?! Do they think we’re stupid?

I am all for the unusual punishments suggested by Dr Brady Smith

How dob you all handle these patients?

Ps trying something different today on the advice of many of you. I intended this for stories when I filmed it but posting it as a reel. Regardless, filming the rants is highly therapeutic so I thank you.

06/11/2026

Cmon, who are you? Look us all in the eye and explain yourself.

And the crazier part is, the patient said it didn’t even work for her. Which makes me think it was either a misdiagnosis or under treatment.

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1325 Franklin Avenue Suite 101
Garden City, NY
11530

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