Diagnosis and Management of Lingual Nerve Injuries

Evaluating Lingual Nerve Repair Outcomes: A Systematic Review

PURPOSE

The lingual nerve (LN) is susceptible to injury during oral and maxillofacial procedures, leading to neurosensory deficits. Advances in microsurgical techniques necessitate a comprehensive review of overall effectiveness and influencing factors.

METHODS

A systematic review was performed via Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies. Inclusion criteria were full text availability, studies written in english, and studies published after 2000 reporting LN repair. The primary outcome was sensory improvement defined via functional sensory recovery (FSR) or neurosensory testing (NST). Sex, time from injury to repair, method of repair, and graft length were examined to see if each influenced outcomes.

RESULTS

A sample of 786 subjects across 17 studies was examined. Most patients were female (73.3%) and suffered injuries from third molar extractions (72.8%). Of the studies, 10 defined improvement by FSR with a total of 88.8% (500/563) of nerves achieving such. Of those achieving FSR, 91% did so within a year. The remaining 7 studies defined sensory improvement by individually setting various NST thresholds, with the combined improvement rate being 88.6% (203/229). Positive outcomes were achieved with graft lengths up to 70 mm. Results on time to repair were mixed. The methods of repairs were not different based on statistical analysis short of performing an equivalence trial.

CONCLUSION

Conclusions made from studies using FSR were similar to studies using NST, meaning the method of measuring outcomes does not seem to be a confounder. FSR is the superior scale due to being objective and standardized. LN repair produced high rates of sensory improvement, which is expected to occur within 1 year postoperative. Sex and graft length did not influence outcomes. More research is needed to determine the effect of time to repair on efficacy. Most methods of repair produced similar outcomes, suggesting multiple valid techniques exist.

Prevalence of lingual sensory impairment following bilateral sagittal split osteotomy: a systematic review and meta-analysis

PURPOSE

Our study aims to estimate the prevalence of lingual nerve injury following bilateral sagittal split osteotomy (BSSO).

METHODS

Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed.

RESULTS

In total, eleven eligible studies comprising a total of 1,882 participants were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of lingual sensory impairment was estimated to be as high as 0.1% (95% CI 0.0%-0.6%) with moderate heterogeneity observed between studies.

CONCLUSION

It is important for healthcare professionals to be aware of this issue, despite the relatively low rate of lingual nerve deficit after BSSO. Additional research will provide a more comprehensive understanding of the underlying factors contributing to lingual nerve injury, leading to improved preventive measures and treatment strategies. Furthermore, insights gained from future studies will enable healthcare professionals to inform patients about the potential complications and manage their expectations before undergoing BSSO.

Advances in Regenerative Dentistry Approaches: An Update

Regenerative dentistry is a rapidly evolving field in dentistry, which has been driven by advancements in biomedical engineering research and the rising treatment expectations and demands that exceed the scope of conventional approaches. Tissue engineering, the foundation of regenerative dentistry, mainly focuses on 3 key components: stem cells, bioactive molecules, and scaffolds. Dental tissue-derived stem cells are especially significant in this regard due to their remarkable properties. Regenerative techniques have provided novel approaches to many conventional treatment strategies in various disciplines of dentistry. For instance, regenerative endodontic procedures such as pulp revascularisation have provided an alternative approach to conventional root canal treatment. In addition, conventional surgical and nonsurgical periodontal treatment is being taken over by modified approaches of guided tissue regeneration with the aid of 3-dimensional bioprinting and computer-aided design, which has revolutionised oral and maxillofacial tissue engineering. This review presents a concise overview of the latest treatment strategies that have emerged into clinical practice, potential future technologies, and the role of dental tissue-derived stem cells in regenerative dentistry.

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review

Injury to the peripheral branches of the trigeminal nerve, particularly the lingual nerve (LN) and the inferior alveolar nerve (IAN), is a rare but serious complication that can occur during oral and maxillofacial surgery. Mandibular third molar surgery, one of the most common surgical procedures in dentistry, is most often associated with such a nerve injury. Proper preoperative radiologic assessment is hence key to avoiding neurosensory dysfunction. In addition to the well-established conventional X-ray-based imaging modalities, such as panoramic radiography and cone-beam computed tomography, radiation-free magnetic resonance imaging (MRI) with the recently introduced black-bone MRI sequences offers the possibility to simultaneously visualize osseous structures and neural tissue in the oral cavity with high spatial resolution and excellent soft-tissue contrast. Fortunately, most LN and IAN injuries recover spontaneously within six months. However, permanent damage may cause significant loss of quality of life for affected patients. Therefore, therapy should be initiated early in indicated cases, despite the inconsistency in the literature regarding the therapeutic time window. In this report, we present the visualization of two cases of nerve pathology using 3D double-echo steady-state MRI and evaluate evidence-based decision-making for iatrogenic nerve injury regarding a wait-and-see strategy, conservative drug treatment, or surgical re-intervention.