Introduction <p>The surgical extraction of impacted mandibular third molars (IMTM) is a cornerstone of routine maxillofacial practice, requiring precise preoperative evaluation via panoramic radiography (PR) and cone-beam computed tomography (CBCT) to mitigate the inherent risk of inferior alveolar nerve (IAN) injury. Therefore, this study aimed to quantify IAN compression using 3D segmentation, and correlate the degree of canal compression with PR signs, canal course, and level of impaction.</p> Materials and Methods <p>A retrospective analysis was conducted on 160 patients with IMTMs who had existing PR and CBCT scans. PR signs indicating IAN proximity were classified according to the Rood and Shehab criteria. Corresponding CBCT images were segmented using ITK-SNAP software to quantify nerve compression. Descriptive statistics were calculated, and the relationships between the degree of compression, canal course, level of impaction, and panoramic signs were evaluated using chi-square tests.</p> Results <p>Statistical analysis revealed a significant association between the degree of canal compression and both the level of impaction (<i>p</i> &lt; 0.001) and PR signs (<i>p</i> &lt; 0.001). Additionally, the course of the canal demonstrated a statistically significant correlation with the severity of compression (<i>p</i> = 0.002).</p> Conclusion <p>Deep impaction, interradicular canal courses, and specific PR signs (darkening of the root, cortical interruption) are significant predictors of moderate-to-severe IAN compression. Identifying these high-risk indicators is essential for preoperative surgical planning to minimize the risk of postoperative neurosensory disturbances.</p>