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Ghasemi S, Babaloo A, Sadighi M, Torab Z, Mohammadi H, Khodadust E. Effect of vitamin B complex administration on pain and sensory problems related to inferior alveolar nerve damage following mandibular implant placement surgery. JOURNAL OF ADVANCED PERIODONTOLOGY & IMPLANT DENTISTRY 2022; 14:13-19. [PMID: 35919449 PMCID: PMC9339724 DOI: 10.34172/japid.2022.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/24/2022] [Indexed: 11/09/2022]
Abstract
Background. Inferior alveolar nerve damage can lead to mild to severe paresthesia and even facial pain. One of the treatments considered today for the reconstruction and treatment of damaged peripheral nerves is the use of vitamin supplements. This study aimed to evaluate the effect of vitamin B complex supplementation on pain and sensory problems following mandibular implant placement surgery. Methods. In this single-blind clinical trial, 46 patients applying for implant placement, who were eligible for the study, were evaluated. All the patients were examined for sensory facial injury and inferior alveolar nerve injury within 24 hours after implant placement. The nerve damage was recorded by AI (asymmetry index) in the initial examination. Patients who reported clinical and radiographic signs of nerve damage due to implant or drill impingement of the nerve canal were excluded from the study and promptly treated with anti-inflammatory protocols. Then the patients were randomly divided into control (n=23) and intervention (n=23) groups. Patients in the control group received routine treatment after implantation, and patients in the intervention group received vitamin B complex pills in addition to routine treatment. A placebo was used to eliminate the inductive effect of the drug in the control group. Follow-up of patients was performed at intervals of 14 days and 1, 2, and 3 months after treatment. Data analysis was performed using SPSS 24 and Kruskal-Wallis, Wilcoxon, and chi-squared tests. Results. In both groups, a decreasing trend in pain intensity was observed for up to three months. There were no significant differences between the mean pain intensity in the intervention and control groups at all the follow-up intervals. In both groups, a decrease in the rate of paresthesia was observed during the 3-month follow-up. The mean of paresthesia in the two groups was not significantly different at any follow-up interval. Conclusion. Vitamin B complex might not affect pain intensity and paresthesia after implant surgery.
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Affiliation(s)
- Shima Ghasemi
- Department of Prosthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amirreza Babaloo
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrnoosh Sadighi
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Torab
- Department of Pediatric Dentistry, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamidreza Mohammadi
- Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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Trigeminal Traumatic Neuroma: a Comprehensive Review of the Literature Based On a Rare Case. Curr Pain Headache Rep 2022; 26:219-233. [PMID: 35119601 DOI: 10.1007/s11916-022-01018-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Traumatic neuromas in general, and trigeminal traumatic neuromas in particular, are relatively rare entities originating from a damage to a corresponding nerve or its branches. This manuscript is a comprehensive review of the literature on trigeminal traumatic neuromas based on an interesting and challenging case of bilateral intraoral lesions. RECENT FINDINGS The diagnosis for this patient was bilateral trigeminal traumatic neuromas. It is possible that these patients have a genetic predisposition to the development of these lesions. It is a neuropathic pain condition and may mimic dental and other trigeminal pain entities. Topical treatment with lidocaine gel, utilizing a custom-made neurosensory stent, rendered the patient significant and sustained pain relief. Trigeminal traumatic neuromas present a diagnostic challenge even to a seasoned clinician, due to the complex clinical features that may mimic other entities. Topical medications such as local anesthetics may be a good viable alternative to systemic medications to manage the pain associated with the condition. Early identification of the lesion and the associated pain helps in the succinct management of symptomatic trigeminal traumatic neuromas.
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Zuniga JR, AbdelBaky O, Alian A, Thakur U, Pezeshk P, Xi Y, Chhabra A. Does Presurgical Magnetic Resonance Neurography Predict Surgical Gap Size in Trigeminal Class IV and V Injuries? J Oral Maxillofac Surg 2021; 79:2574-2581. [PMID: 34453910 DOI: 10.1016/j.joms.2021.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The accuracy of magnetic resonance neurography (MRN) for quantitative assessment of nerve injury gap is unknown. We tested the hypothesis that presurgical MRN predicts the final surgical gap size after neuroma resection at the time of surgery. MATERIALS AND METHODS This was a retrospective, single-blinded, nonrandomized cohort study on 43 patients with Sunderland Class IV and V injuries of the inferior alveolar (IAN) or the lingual nerve (LN). The MRN maxillofacial protocol was performed on a 3T scanner and was read by 2 musculoskeletal radiologists to determine the maximum size of neuroma and the abnormal nerve segment. Two independent variables were recorded during surgery: 1) the length of neuroma from histologic specimens since only 9 of the 43 neuroma size measurements were accurately measureable at the time of surgery; and 2) the length of nerve gap size after the neuroma was removed and normal fascicles were identified. RESULTS There were 7 IAN and 36 LN cases analyzed. The mean time in months from injury to MRN was 6.97 ± 9.18 and MRN to surgery was 1.21 ± 1.4. The mean length of the neuroma at surgery was 7.22 ± 2.78 mm and mean nerve gap size was 12.02 ± 4.41 mm. Intraclass coefficient (ICC) agreement was fair for abnormal nerve thickness and neuroma length (ICC = 0.28, 0.39) while it was moderate for neuroma thickness and abnormal nerve length (0.50, 0.59). There was no significant correlation between MRN based measurements and surgical gap size for both readers (P > .05). CONCLUSIONS Abnormal nerve and neuromas of the peripheral trigeminal nerve as identified on MRN imaging demonstrates no correlation of the assessed MRN findings with the final surgical gap after neuroma removal.
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Affiliation(s)
- John R Zuniga
- Professor, Robert V. Walker Chair in Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Surgery, Departments of Surgery and Neurology, University of Texas Southwestern, Dallas, TX.
| | - Omar AbdelBaky
- Resident, Oral and Maxillofacial Surgery, Parkland Hospital, Dallas, TX
| | - Ali Alian
- Fellow, Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Uma Thakur
- Assistant Professor, Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Parham Pezeshk
- Assistant Professor, Department of Radiology, University of Texas Southwestern, Dallas, TX
| | - Yin Xi
- Assistant Professor, Departments of Radiology and Population & Data Sciences, University of Texas Southwestern, Dallas, TX
| | - Avneesh Chhabra
- Associate Professor, Radiology & Orthopedic Surgery, Chief Musculoskeletal Radiology, Department of Radiology, University of Texas Southwestern, Dallas, TX
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Meewis J, Renton T, Jacobs R, Politis C, Van der Cruyssen F. Post-traumatic trigeminal neuropathy: correlation between objective and subjective assessments and a prediction model for neurosensory recovery. J Headache Pain 2021; 22:44. [PMID: 34030632 PMCID: PMC8146662 DOI: 10.1186/s10194-021-01261-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Post-traumatic trigeminal neuropathy (PTN) can have a substantial effect on patient well-being. However, the relation between the neuropathic symptoms and their effect on psychosocial functioning remains a matter of debate. The purpose of this study was to evaluate the association between objective and subjective assessments of neurosensory function in PTN and predict neurosensory outcome using baseline measurements. METHODS This prospective observational cohort study included patients diagnosed with PTN at the Department of Oral and Maxillofacial Surgery, University Hospital Leuven, Belgium, between April 2018 and May 2020. Standardized objective and subjective neurosensory examinations were recorded simultaneously on multiple occasions during the follow-up period. Correlation analyses and principal component analysis were conducted, and a prediction model of neurosensory recovery was developed. RESULTS Quality of life correlated significantly (P < 0.05) with percentage of affected dermatome (ρ = - 0.35), the presence of brush stroke allodynia (ρ = - 0.24), gain-of-function sensory phenotype (ρ = - 0.41), Medical Research Council Scale (ρ = 0.36), and Sunderland classification (ρ = - 0.21). Quality of life was not significantly correlated (P > 0.05) with directional discrimination, stimulus localization, two-point discrimination, or sensory loss-of-function. The prediction model showed a negative predictive value for neurosensory recovery after 6 months of 87%. CONCLUSIONS We found a strong correlation of subjective well-being with the presence of brush stroke allodynia, thermal and/or mechanical hyperesthesia, and the size of the neuropathic area. These results suggest that positive symptoms dominate the effect on affect. In patients reporting poor subjective well-being in the absence of positive symptoms or a large neuropathic area, additional attention towards psychosocial triggers might enhance treatment outcome. The prediction model could contribute to establishing realistic expectations about the likelihood of neurosensory recovery but remains to be validated in future studies.
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Affiliation(s)
- Jeroen Meewis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium.
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium.
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Fréderic Van der Cruyssen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 33, 3000, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
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Nunes T, Caetano C, Pimenta M, Saraiva J, Rocha S, Freitas P, Figueiredo J, Pereira SA, Corte-Real A. UC-USP collaborative exercise on photobiomodulation therapy in neurological orofacial disturbances. J Clin Exp Dent 2020; 12:e650-e655. [PMID: 32904953 PMCID: PMC7462374 DOI: 10.4317/jced.56839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/26/2020] [Indexed: 11/08/2022] Open
Abstract
Background Neurosensory peripheral disorders are one of the most common risks associated with iatrogenic and/or post-traumatic injuries. It is often related to disability. Photobiomodulation therapy (PBMT) is a nonsurgical and safe procedure which can accelerate and improve the regeneration of injured biological tissue. This study aims to analyze the impact of PBMT, in the quality of life and impairment of individuals with orofacial neurological peripheral disturbance.
Material and Methods A retrospective analysis in the database of the dental traumatology clinic of the Hospital Centre of the University of Coimbra/Faculty of Medicine of the University of Coimbra was performed.5 out of 50 individuals were selected, according to the selection criteria. The neurosensory activity was assessed by a pinprick nociceptive test and the EQ-5D-5L self-report questionnaire was used to analyse the quality of life. The study was performed in two phases:1) inactive laser or placebo phase, for one month and 2) active laser or treatment phase. A diode low-level laser device (SIROLaserBlue;Sirona,Germany) was used, according to our protocol. A collaborative protocol in the PBMT influence in individuals with neurosensory peripheral disturbances was studied.
Results There was no improvement in the neurosensory activity nor in the quality of life, in the placebo phase. After the treatment phase, the EQ-5D-5L final results reported no problems in all of the five dimensions, except for anxiety/depression in individuals with long-standing neurosensory peripheral disturbances. The EQ-VAS scores increased in all the individuals.
Conclusions Our results supported the improvement of quality of life and impairment reduction in the individuals submitted to PBMT. Key words:Low-level light therapy, peripheral nerve injuries, sensation disorders, quality of life, forensic medicine.
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Affiliation(s)
- Tiago Nunes
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Catarina Caetano
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Forensic Dentistry Laboratory, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Pimenta
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - José Saraiva
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Salomão Rocha
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Patrícia Freitas
- Special Laboratory of Lasers in Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - José Figueiredo
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Ana Corte-Real
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Forensic Dentistry Laboratory, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Kaleem A, Amailuk P, Hatoum H, Tursun R. The Trigeminal Nerve Injury. Oral Maxillofac Surg Clin North Am 2020; 32:675-687. [PMID: 32912777 DOI: 10.1016/j.coms.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Trigeminal nerve branches are never far from the operating field of the oral and maxillofacial surgeon. Increasingly the surgeon is required to provide accurate diagnosis and grading of trigeminal nerve injury, and surgical management by oral and maxillofacial surgeons will become common. Although trauma and ablative procedures for head and neck pathology can cause injuries, dentoalveolar surgical procedures remain an important cause of injury to the fifth cranial nerve, with the third division being the main branch affected. Oral and maxillofacial surgeons should be aware of strategies of avoiding iatrogenic injury, and know when referral and surgical management are appropriate.
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Affiliation(s)
- Arshad Kaleem
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA
| | - Paul Amailuk
- Department of oral and maxillofacial surgery, Gold Coast University Hospital, 1 hospital Boulevard, Queensland 4215, Australia
| | - Hisham Hatoum
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA
| | - Ramzey Tursun
- Division of Oral & Maxillofacial Surgery, Department of Surgery, University of Miami, Deering Medical Plaza, 9380 Southwest 150th Street, Suite 170, Miami, FL 33176, USA.
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Atkins S, Kyriakidou E. Clinical outcomes of lingual nerve repair. Br J Oral Maxillofac Surg 2020; 59:39-45. [PMID: 32800402 DOI: 10.1016/j.bjoms.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Lingual nerve injury, a well-described complication of third molar removal, may result in permanent lingual sensory deficit leading to symptoms including lost or altered sensation, inadvertent tongue biting, and the development of unpleasant neuropathic pain, with consequent impaired quality of life. We analysed outcomes of a prospective case series to determine whether direct anastomosis of the lingual nerve results in improved sensory recovery and reduced neuropathic pain, and whether delayed surgery is worthwhile. In 114 patients who underwent nerve repair at our nerve injury clinic following damage sustained during mandibular third molar removal, sensory deficit was assessed before and after surgery using a questionnaire and visual analogue scales (VAS) to assess pain, tingling, and discomfort. Neurosensory tests were utilised to evaluate light touch, pin-prick, and two-point discrimination thresholds. Subjectively, 94% patients felt their sensation had improved following nerve repair, with significant reductions in the incidence of tongue biting (p<0.0001), impaired speech (p<0.0001), and neuropathic pain (p=0.0017). Quantitative neurosensory data showed highly significant improvements in light touch, pin-prick, and two-point discrimination (all p<0.0001), and VAS scores for pain (p=0.0145), tingling (p<0.0025), and discomfort (p<0.0001) were significantly reduced. Patients with high levels of pain preoperatively (VAS>40) showed highly significant reductions in pain (p<0.0001). No correlation was found between surgical outcome and patient's age or delay until surgery. Lingual nerve repair results in good sensory outcomes and significant improvements in the incidence and degree of neuropathic pain, even when delayed.
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Affiliation(s)
- S Atkins
- Unit of Oral and Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, UK.
| | - E Kyriakidou
- Unit of Oral and Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, UK.
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de Toledo Telles-Araújo G, Peralta-Mamani M, Caminha RDG, de Fatima Moraes-da-Silva A, Rubira CMF, Honório HM, Rubira-Bullen IRF. CBCT does not reduce neurosensory disturbances after third molar removal compared to panoramic radiography: a systematic review and meta-analysis. Clin Oral Investig 2020; 24:1137-1149. [PMID: 32052178 DOI: 10.1007/s00784-020-03231-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 01/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The current dentistry scenario is showing an increase in the availability of cone-beam computed tomography (CBCT) in dental offices. Oral surgeons are using three-dimensional information as an additional tool to assess preoperative data for lower third molar (LTM) removal in moderate and high-risk cases of inferior alveolar nerve (IAN) injury diagnosed through the panoramic radiography (PR). The aim of this study is to identify whether CBCT examination reduces neurosensoric disturbances (ND) following the removal of the LTM when compared to PR. MATERIALS AND METHODS PubMed, Embase, Web of Science, Science Direct, and Scopus electronic databases were searched for studies published up to February 2019. The gray literature was also searched including papers that eventually met the eligibility criteria. Meta-analysis was performed using the comprehensive meta-analysis software, p < 0.05 considered significant. RESULTS Among the search, 6 studies met all eligibility criteria. There was no statistically significant difference between the two groups (PR and CBCT) in all six studies regarding reducing ND (95%. Confidence interval, 0,788-1734; heterogeneity: Q = 10,361; I2 = 22.788%). CONCLUSIONS CBCT was not superior to PR in avoiding ND. However, further studies are necessary with standardized parameters for a better comparability between variables in the studies. CLINICAL RELEVANCE To better understand the CBCT clinical applicability in LTM removal to avoid unnecessary extra radiation when compared to PR to the patient and to improve patient's prognosis.
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Affiliation(s)
- Gabriel de Toledo Telles-Araújo
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Mariela Peralta-Mamani
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Raquel D'Aquino Garcia Caminha
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Cássia Maria Fischer Rubira
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Heitor Marques Honório
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Leung YY. Management and prevention of third molar surgery-related trigeminal nerve injury: time for a rethink. J Korean Assoc Oral Maxillofac Surg 2019; 45:233-240. [PMID: 31728330 PMCID: PMC6838349 DOI: 10.5125/jkaoms.2019.45.5.233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 12/26/2022] Open
Abstract
Trigeminal nerve injury as a consequence of lower third molar surgery is a notorious complication and may affect the patient in long term. Inferior alveolar nerve (IAN) and lingual nerve (LN) injury result in different degree of neurosensory deficit and also other neurological symptoms. The long term effects may include persistent sensory loss, chronic pain and depression. It is crucial to understand the pathophysiology of the nerve injury from lower third molar surgery. Surgery remains the most promising treatment in moderate-to-severe nerve injuries. There are limitations in the current treatment methods and full recovery is not commonly achievable. It is better to prevent nerve injury than to treat with unpredictable results. Coronectomy has been proved to be effective in reducing IAN injury and carries minimal long-term morbidity. New technologies, like the roles of erythropoietin and stem cell therapy, are being investigated for neuroprotection and neural regeneration. Breakthroughs in basic and translational research are required to improve the clinical outcomes of the current treatment modalities of third molar surgery-related nerve injury.
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Affiliation(s)
- Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong
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Araujo GDTT, Peralta-Mamani M, Silva ADFMD, Rubira CF, Honório HM, Rubira-Bullen IF. Influence of cone beam computed tomography versus panoramic radiography on the surgical technique of third molar removal: a systematic review. Int J Oral Maxillofac Surg 2019; 48:1340-1347. [DOI: 10.1016/j.ijom.2019.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 04/08/2019] [Indexed: 12/16/2022]
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Freire BB, Nascimento EHL, Vasconcelos KDF, Freitas DQ, Haiter-Neto F. Radiologic assessment of mandibular third molars: an ex vivo comparative study of panoramic radiography, extraoral bitewing radiography, and cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:166-175. [DOI: 10.1016/j.oooo.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 11/01/2018] [Accepted: 11/10/2018] [Indexed: 11/28/2022]
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12
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Na JY, Han SS, Jeon K, Choi YJ, Choi SH, Lee C. Prognosis in case of nerve disturbance after mandibular implant surgery in relation to computed tomography findings and symptoms. J Periodontal Implant Sci 2019; 49:127-135. [PMID: 31098333 PMCID: PMC6494770 DOI: 10.5051/jpis.2019.49.2.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 03/13/2019] [Indexed: 11/08/2022] Open
Abstract
Purpose The aim of this study was to evaluate the computed tomography (CT) imaging findings and clinical symptoms of patients who complained of neurosensory disturbances after mandibular implant surgery, and to investigate the relationships of these parameters with the prognosis for recovery. Methods CT scans were reviewed in 56 patients with nerve disturbance after mandibular implant surgery. Two oral radiologists classified the imaging findings into intrusion, contact, close, and separate groups according to the distance from the inferior border of the implant to the roof of the mandibular canal (MC). The symptoms of 56 patients were classified into 8 groups and the frequency of each group was investigated. Patients were categorized according to symptom improvement into no recovery and recovery groups, and the relationships of recovery with the CT classification and specific symptom groups were analyzed. Results Thirty-eight of the 56 nerve disturbance cases showed improvement. The close and separate groups in the CT classification had a strong tendency for recovery (90.9% and 81.8%, respectively) (P<0.05). Although the lowest recovery rate was found in the intrusion group, it was non-negligible, at 50%. The 6 patients with a worm crawling feeling all improved, while the 8 cases with a tightening sensation showed the lowest recovery rate, at 12.5%, and the symptom of a tightening sensation occurred only in the intrusion and contact groups. Conclusions The closer the implant fixture was to the MC on CT images, the less likely the patient was to recover. Regarding paresthesia symptoms, while a worm crawling feeling is thought to be a predictor of recovery, a tightening sensation appeared to be associated with a lower recovery rate.
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Affiliation(s)
- Ji Yeon Na
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - KugJin Jeon
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Yoon Joo Choi
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Seong Ho Choi
- Department of Periodontology, Yonsei University College of Dentistry, Seoul, Korea
| | - Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
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Uzun T, Toptas O, Saylan A, Carver H, Turkoglu SA. Evaluation and Comparison of the Effects of Artesunate, Dexamethasone, and Tacrolimus on Sciatic Nerve Regeneration. J Oral Maxillofac Surg 2018; 77:1092.e1-1092.e12. [PMID: 30689960 DOI: 10.1016/j.joms.2018.12.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/23/2018] [Accepted: 12/23/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To examine the effect of topical artesunate treatment on peripheral nerve regeneration and compare it with the effects of topical tacrolimus and dexamethasone on nerve regeneration. MATERIALS AND METHODS Thirty-two Wistar albino rats were used in this study. The rats were divided into 6 groups: sham, saline, petrolatum, artesunate, tacrolimus, and dexamethasone. A compression injury was generated in the right sciatic nerve in all groups except the sham group. In the sham group, the nerve was dissected but compression was not applied. In the groups in which compression was applied, the agents were absorbed through resorbable gelatin sponges applied to the injured region. At the end of 4 weeks, walking analysis, electromyographic measurements, and histopathologic examinations were conducted. RESULTS When the sciatic function index and electrophysiologic measurements were evaluated, artesunate, tacrolimus, and dexamethasone exhibited positive effects on nerve regeneration (P < .05); there were no significant differences among these 3 agents (P > .05). Histopathologic examination showed that artesunate decreased fibrosis scores and inflammation and increased the diameter of myelinated axons; tacrolimus decreased fibroblast scores; and dexamethasone only decreased fibrosis scores (P < .05). Immunohistochemical analysis showed that the artesunate and dexamethasone groups had more positive immunoreactivity to nerve growth factor than did the saline group (P < .05). CONCLUSIONS Topical artesunate treatment had a positive effect on peripheral nerve regeneration. There were no relevant differences between the topical forms of dexamethasone and tacrolimus for peripheral nerve regeneration.
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Affiliation(s)
- Tugcenur Uzun
- Private Practitioner, Department of Oral and Maxillofacial Surgery, Abant İzzet Baysal University, Samsun, Turkey. tugce--
| | - Orcun Toptas
- Associate Professor, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Abant İzzet Baysal University, Samsun, Turkey
| | - Aslihan Saylan
- Assistant Professor, Faculty of Medicine, Department of Histology and Embryology, Abant İzzet Baysal University, Samsun, Turkey
| | - Hande Carver
- Research Assistant, Faculty of Medicine, Department of Histology and Embryology, Abant İzzet Baysal University, Samsun, Turkey
| | - Sule Aydın Turkoglu
- Assistant Professor, Faculty of Medicine, Department of Neurology, Abant İzzet Baysal University, Samsun, Turkey
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Affiliation(s)
- Tara Renton
- King's College London Dental Institute; London UK
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15
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Abstract
With the growing demand for dental work, trigeminal nerve injuries are increasingly common. This retrospective cohort study examined 53 cases of iatrogenic trigeminal nerve injury seen at the Department of Oral and Maxillofacial Surgery, University Hospitals of Leuven between 2013 and 2014 (0.6% among 8845 new patient visits). Patient records were screened for post-traumatic trigeminal nerve neuropathy caused by nerve injury incurred during implant surgery, endodontic treatment, local anaesthesia, tooth extraction, or specifically third molar removal. The patients ranged in age from 15 to 80years (mean age 42.1years) and 68% were female. The referral delay ranged from 1day to 6.5years (average 10months). The inferior alveolar nerve (IAN) was most frequently injured (28 cases), followed by the lingual nerve (LN) (21 cases). Most nerve injuries were caused during third molar removal (24 cases), followed by implant placement (nine cases) and local anaesthesia injuries (nine cases). Pain symptoms were experienced by 54% of patients suffering IAN injury, compared to 10% of patients with LN injury. Persistent neurosensory disturbances were identified in 60% of patients. While prevention remains the key issue, timely referral seems to be a critical factor for the successful treatment of post-traumatic neuropathy.
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16
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Bataineh AB, Al-Sabri GA. Extraction of Maxillary Teeth Using Articaine Without a Palatal Injection: A Comparison Between the Anterior and Posterior Regions of the Maxilla. J Oral Maxillofac Surg 2017; 75:87-91. [DOI: 10.1016/j.joms.2016.06.192] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
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17
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Patel N, Ali S, Yates J. Quality of life following injury to the inferior dental or lingual nerve - a cross-sectional mixed-methods study. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ors.12259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- N. Patel
- Department of Oral Surgery; The University of Manchester; School of Dentistry; Manchester UK
| | - S. Ali
- Department of Special Care Dentistry; University Hospital Bristol; Bristol UK
| | - J.M. Yates
- Department of Oral and Maxillofacial Surgery; The University of Manchester; School of Dentistry; Manchester UK
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18
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Use of Fibrin Glue as an Adjunct in the Repair of Lingual Nerve Injury: Case Report. J Oral Maxillofac Surg 2016; 74:1899.e1-4. [PMID: 27235179 DOI: 10.1016/j.joms.2016.04.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
Abstract
This report describes a case of lingual nerve injury repair using a novel technique in which Tisseel fibrin glue was used to stabilize an Axoguard nerve conduit placed around the site of primary neurorrhaphy to decrease the number of sutures required for stabilization. Five months postoperatively, the patient subjectively had increased sensation and improved taste in the left lingual nerve distribution. At neurosensory examination, the patient exhibited functional neurosensory recovery (S3+ on the Medical Research Council Scale).
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19
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Cox B, Zuniga JR, Panchal N, Cheng J, Chhabra A. Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre. Eur Radiol 2016; 26:3392-400. [PMID: 26795500 DOI: 10.1007/s00330-015-4182-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/14/2015] [Accepted: 12/18/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies. MATERIALS AND METHODS Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed. RESULTS Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases. CONCLUSION MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings. KEY POINTS • MRN substantially impacts diagnostic thinking and management in peripheral trigeminal neuropathy. • MRN has moderate-to-excellent correlation with intra-operative findings. • MRN should be considered in pre-surgical planning of peripheral trigeminal neuropathy subjects.
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Affiliation(s)
- Brian Cox
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - John R Zuniga
- Department of Oral & Maxillofacial Surgery, Surgery, Neurology & Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neeraj Panchal
- Department of Oral Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jonathan Cheng
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.
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20
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Abstract
This article aims to cover post surgical trigeminal neuropathy and other conditions related to chronic trigeminal pain not specifically covered elsewhere in this series.Is estimated to occur in 4-5% of patients overall, considerably less compared with other site surgeries.Due to the high volume surgery undertaken in this region chronic post surgical pain remains common.Relatively few clinicians are aware of this condition and as a result it is frequently poorly managed.
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Affiliation(s)
- Tara Renton
- Professor in Oral Surgery, King's College London Dental Institute, Denmark Hill Campus, Bessemer Road, London SE5 9RS
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21
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22
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Abstract
Injuries to branches of the trigeminal nerves are a known complication during dental implant placement. These injuries tend to be more severe than those experienced during other dentoalveolar procedures. This article reviews the types of nerve injuries and areas and situations of which clinicians should be cognizant when placing dental implants. Strategies to avoid injuries, and a management algorithm for suspected nerve injuries, are also discussed.
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Affiliation(s)
- Mark J Steinberg
- Division of Oral and Maxillofacial Surgery, Loyola University Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153, USA; Private Practice, Northbrook, 1240 Meadow Rd, IL 60062, USA
| | - Patrick D Kelly
- Division of Oral and Maxillofacial Surgery, Loyola University Stritch School of Medicine, Loyola University Medical Center, 2160 South First Avenue, Maguire Building #105, Room 1814, Maywood, IL 60153, USA.
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23
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Abstract
OBJECTIVES This article proposes a simple preoperative score to evaluate the complexity of tooth extractions of the third mandibular molar and to estimate the time involved. STUDY DESIGN We consider 11 factors (demographic, anatomic, and radiologic) that favor the surgery and that can be identified through standard clinical and radiologic examinations. The number of favorable factors (NFF) relative to each patient constitutes his/her score. The analysis of 1500 extractions performed by various surgeons with experience from 2 to 25 years evidences a quadratic inverse correlation between NFF and the time required for the surgery. RESULTS The shape of the time distribution suggests the existence of 3 major classes of patients characterized by time of 4 to 10 minutes, 11 to 20 minutes, and 21 to 40 minutes. The corresponding NFF brackets, as identified by their frequency distributions and validated by the receiver operating characteristic curve method, are 5 to 11 (mean [SD], 6.8 [1.6]), 2 to 4 (3.3 [1.3]), and 0 to 1 (0.8 [1.0]), respectively. CONCLUSIONS Our results show the good performance of this score as a predictor of the surgical time and its applicability in daily practice regardless of operator experience, background, and level of surgical ability.
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Du Toit J, Gluckman H, Gamil R, Renton T. Implant Injury Case Series and Review of the Literature Part 1: Inferior Alveolar Nerve Injury. J ORAL IMPLANTOL 2014; 41:e144-51. [PMID: 24945089 DOI: 10.1563/aaid-joi-d-14-00022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Injury to adjacent structures is an unfortunate and avoidable outcome of oral implant placement surgery. Paramount among these is perforation into paranasal sinus; into neighboring tooth root; through cortical plate; and into vessels, canals, and, most importantly, nerves. In most cases, injudicious oral implant placement can be attributed to poor treatment planning. We present the cases of several patients referred for postsurgical radiology that illustrate injury to the inferior alveolar canal by implant impingement, penetration, and even complete obliteration of the nerve and canal in the absence of proper treatment planning and imaging modalities. The authors stress the importance of thorough implant case preparation and planning, which may include the use of cone beam computerized tomography in order to minimize nerve injury.
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Affiliation(s)
- Jonathan Du Toit
- 1 Department of Oral Medicine & Periodontology, University of the Witwatersrand, Johannesburg, South Africa
| | - Howard Gluckman
- 1 Department of Oral Medicine & Periodontology, University of the Witwatersrand, Johannesburg, South Africa
| | - Rami Gamil
- 1 Department of Oral Medicine & Periodontology, University of the Witwatersrand, Johannesburg, South Africa
| | - Tara Renton
- 2 Department of Oral Surgery, King's College London Dental Institute, London, United Kingdom
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25
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Coulthard P, Kushnerev E, Yates JM, Walsh T, Patel N, Bailey E, Renton TF. Interventions for iatrogenic inferior alveolar and lingual nerve injury. Cochrane Database Syst Rev 2014; 2014:CD005293. [PMID: 24740534 PMCID: PMC10794896 DOI: 10.1002/14651858.cd005293.pub2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Iatrogenic injury of the inferior alveolar or lingual nerve or both is a known complication of oral and maxillofacial surgery procedures. Injury to these two branches of the mandibular division of the trigeminal nerve may result in altered sensation associated with the ipsilateral lower lip or tongue or both and may include anaesthesia, paraesthesia, dysaesthesia, hyperalgesia, allodynia, hypoaesthesia and hyperaesthesia. Injury to the lingual nerve may also affect taste perception on the affected side of the tongue. The vast majority (approximately 90%) of these injuries are temporary in nature and resolve within eight weeks. However, if the injury persists beyond six months it is deemed to be permanent. Surgical, medical and psychological techniques have been used as a treatment for such injuries, though at present there is no consensus on the preferred intervention, or the timing of the intervention. OBJECTIVES To evaluate the effects of different interventions and timings of interventions to treat iatrogenic injury of the inferior alveolar or lingual nerves. SEARCH METHODS We searched the following electronic databases: the Cochrane Oral Health Group's Trial Register (to 9 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 9 October 2013) and EMBASE via OVID (1980 to 9 October 2013). No language restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) involving interventions to treat patients with neurosensory defect of the inferior alveolar or lingual nerve or both as a sequela of iatrogenic injury. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of the risk of bias independently and in duplicate. We contacted authors to clarify the inclusion criteria of the studies. MAIN RESULTS Two studies assessed as at high risk of bias, reporting data from 26 analysed participants were included in this review. The age range of participants was from 17 to 55 years. Both trials investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury.Patient-reported altered sensation was partially reported in one study and fully reported in another. Following treatment with laser therapy, there was some evidence of an improvement in the subjective assessment of neurosensory deficit in the lip and chin areas compared to placebo, though the estimates were imprecise: a difference in mean change in neurosensory deficit of the chin of 8.40 cm (95% confidence interval (CI) 3.67 to 13.13) and a difference in mean change in neurosensory deficit of the lip of 21.79 cm (95% CI 5.29 to 38.29). The overall quality of the evidence for this outcome was very low; the outcome data were fully reported in one small study of 13 patients, with differential drop-out in the control group, and patients suffered only partial loss of sensation. No studies reported on the effects of the intervention on the remaining primary outcomes of pain, difficulty eating or speaking or taste. No studies reported on quality of life or adverse events.The overall quality of the evidence was very low as a result of limitations in the conduct and reporting of the studies, indirectness of the evidence and the imprecision of the results. AUTHORS' CONCLUSIONS There is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychological interventions for iatrogenic inferior alveolar and lingual nerve injuries. Primary outcomes of this research should include: patient-focused morbidity measures including altered sensation and pain, pain, quantitative sensory testing and the effects of delayed treatment.
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Affiliation(s)
- Paul Coulthard
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Evgeny Kushnerev
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Julian M Yates
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Tanya Walsh
- School of Dentistry, The University of ManchesterCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Neil Patel
- University Dental Hospital of ManchesterOral SurgeryHigher Cambridge StreetManchesterGreater ManchesterUKM15 6FH
| | - Edmund Bailey
- School of Dentistry, The University of ManchesterDepartment of Oral and Maxillofacial SurgeryCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Tara F Renton
- King's College LondonDepartment of Oral Surgery, Dental InstituteKings Denmark Hill CampusBessemer RdLondonUKSE5 9RW
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26
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Abstract
The purpose of this study is to analyze the incidence of complications in a group of 171 patients in whom extractions of impacted mandibular third molar have been performed by two oral surgeons between the period April 2010 and March 2012. This retrospective study comprises evaluation of 270 impacted mandibular third molars which were classified into two groups A and B on the basis of procedure of osteotomy only and osteotomy and odontotomy both respectively. Total no of complications reported were 40 (14.81%). Maximum no of cases reported alveolar osteitis (AO) (11.11%) while other complications reported root tip fractures (2.22%), lingual nerve parasthesia and TMJ problems (each 0.74%) in descending frequency. Conclusion drawn is that the risk of complications in extractions of impacted mandibular third molars always exists, and extractions associated with both osteotomy and odontotomy are associated with higher risk of complications.
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Affiliation(s)
- Amiya Agrawal
- Reader, Department of Oral and Maxillofacial Surgery, Uttaranchal Dental and Medical Research Institute, Dehradun, Uttarakhand India
| | - Arvind Yadav
- Lecturer, Department of Dentistry, Government Medical College Ambedkar Nagar, Uttar Pradesh, India
| | - Siddhartha Chandel
- Assistant Professor, Department of Dentistry, Era's Lucknow Medical College Lucknow, Uttar Pradesh, India
| | - Nishi Singh
- Senior Lecturer, Department of Periodontics, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Ankita Singhal
- Lecturer, Uttaranchal Dental and Medical Research Institute, Dehradun Uttarakhand, India
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27
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Umar G, Obisesan O, Bryant C, Rood J. Elimination of permanent injuries to the inferior alveolar nerve following surgical intervention of the “high risk” third molar. Br J Oral Maxillofac Surg 2013; 51:353-7. [DOI: 10.1016/j.bjoms.2012.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
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28
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Bagheri SC, Meyer RA, Cho SH, Thoppay J, Khan HA, Steed MB. Microsurgical Repair of the Inferior Alveolar Nerve: Success Rate and Factors That Adversely Affect Outcome. J Oral Maxillofac Surg 2012; 70:1978-90. [DOI: 10.1016/j.joms.2011.08.030] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 08/18/2011] [Accepted: 08/21/2011] [Indexed: 11/30/2022]
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Post-implant neuropathy of the trigeminal nerve. A case series. Br Dent J 2012; 212:E17. [DOI: 10.1038/sj.bdj.2012.497] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2012] [Indexed: 11/09/2022]
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30
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Renton T, Yilmaz Z. Managing iatrogenic trigeminal nerve injury: a case series and review of the literature. Int J Oral Maxillofac Surg 2012; 41:629-37. [DOI: 10.1016/j.ijom.2011.11.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 10/27/2011] [Accepted: 11/08/2011] [Indexed: 11/27/2022]
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31
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Sihler-stain study of buccal nerve distribution and its clinical implications. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113:334-9. [DOI: 10.1016/j.tripleo.2011.03.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 11/20/2022]
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32
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Abstract
The most significant complications from dental surgical interventions are iatrogenic trigeminal nerve injuries, which can result in permanent altered sensation and pain, causing considerable functional and psychological disability. This paper provides some useful tips on minimising the risks of these injuries. By understanding the risk factors and modifying the resulting intervention, more of these injuries may be prevented.
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Affiliation(s)
- Tara Renton
- Professor Tara Renton, Department of Oral Surgery, King’s College London, King’s College Hospital London, Bessemer Road, Denmark Hill, London SE5 9RS E:
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33
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Umar G, Bryant C, Obisesan O, Rood J. Correlation of the radiological predictive factors of inferior alveolar nerve injury with cone beam computed tomography findings. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1752-248x.2010.01088.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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34
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Farole A, Jamal BT. A bioabsorbable collagen nerve cuff (NeuraGen) for repair of lingual and inferior alveolar nerve injuries: a case series. J Oral Maxillofac Surg 2008; 66:2058-62. [PMID: 18848102 DOI: 10.1016/j.joms.2008.06.017] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 01/31/2008] [Accepted: 06/16/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE This study describes the results of using NeuraGen (Integra LifeSciences, Plainsboro, NJ) as a nerve cuff for repair of lingual and inferior alveolar nerve injuries following third molar surgery. PATIENTS AND METHODS Eight female patients received a total of 9 NeuraGen cuffs for repair of lingual (6) or inferior alveolar (3) nerves. All injuries were treated within 3 to 7 months following injury. All patients were evaluated by mechanoceptive and nociceptive testing via brush directional discrimination, pin-prick pressure and thermal sensation. Lateral trap-door osteotomy of the mandible was utilized to access the inferior alveolar nerve. The lingual nerve was approached via a lingual gingival sulcus incision. Following external neurolysis and primary neurorrhaphy, NeuraGen was split longitudinally, and encased the nerve with at least a 1.5 cm margin. One or 2 6-0 prolene horizontal mattress sutures were used to reapproximate the NeuraGen edges and Healon (hyaluronic acid; Advanced Medical Optics, Santa Ana, CA) was applied to the perineural tissues. RESULTS Five injuries resulted in objective anesthesia preoperatively with the other 4 having varying degrees of hypoesthesia. Six of the nerve injuries also resulted in dysesthesia. Four patients were followed for at least 1 year and the other 4 patients for about 2.5 years. The most recent data was used for this study. Postsurgical outcome was assessed utilizing some of the criteria proposed by Pogrel to classify patients as having good improvement, some improvement, no improvement, or worsening of symptoms. Four cases were found to have good improvement, 4 with some improvement and 1 had no improvement. None of the cases had worsening of symptoms. CONCLUSION While reports of the use of other alloplastic materials for nerve repair were found to be variable, NeuraGen seems to have good preliminary results. Bioresorption is complete which decreases the likelihood of interneural scarring. Also, NeuraGen is not associated with episodes of compression neuropathy reported with other rigid non biodegradable materials. Its use in hand surgery literature and in experimental animal studies showed no statistical significance in outcome when compared to end-to-end anastomosis or nerve grafts. The reported advantage of NeuraGen was the elimination of problems associated with graft harvesting. In this small series, 8 out of 9 nerve repairs showed sensory improvement which suggests a favorable role of NeuraGen as a nerve cuff and protective barrier around the nerve injury site. While primary end-to-end anastomosis has comparable results, a nerve cuff has the advantage of preventing axonal escape at suture lines, it minimizes scar ingrowth and nerve entrapment, and it concentrates growth factors at the injury site.
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35
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Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am 2008; 19:117-28, vii. [PMID: 18088870 DOI: 10.1016/j.coms.2006.11.013] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article addresses the incidence of specific complications and, where possible, offers a preventive or management strategy. Injuries of the inferior alveolar and lingual nerves are significant issues that are discussed separately in this text. Surgical removal of third molars is often associated with postoperative pain, swelling, and trismus. Factors thought to influence the incidence of complications after third molar removal include age, gender, medical history, oral contraceptives, presence of pericoronitis, poor oral hygiene, smoking, type of impaction, relationship of third molar to the inferior alveolar nerve, surgical time, surgical technique, surgeon experience, use of perioperative antibiotics, use of topical antiseptics, use of intra-socket medications, and anesthetic technique. Complications that are discussed further include alveolar osteitis, postoperative infection, hemorrhage, oro-antral communication, damage to adjacent teeth, displaced teeth, and fractures.
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Affiliation(s)
- Gary F Bouloux
- Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, 1365-B Clifton Road NE, Suite 2300-B, Atlanta, GA 30322, USA
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