"Knowing It Before Blocking It," the ABCD of the Peripheral Nerves: Part D (Approach to the Patient With Nerve Injuries)

Neurological Complications following Surgical Treatments of the Lower Molars

Aim

The current review aims to explore postoperative neurological complications in third molar extractive surgery.

Materials and Methods

The PRISMA protocols were followed when conducting this review. We found a total of 2,250 articles that matched our topic using the Boolean keywords, mandibular nerve complications AND oral surgery, from PubMed (1,083), Scopus (435), and Web of Science (732), with the filters of English language articles, time range January 1, 2003, to September 30, 2023, and human studies. After 762 duplicates were eliminated, there remained 1,488 articles. Eleven final articles were deemed of the highest relevance to our topic by eliminating articles in animals, non-English language, reviews, meta-analysis, and off-topic. A potential risk in the third molar extraction was temporary loss of sensibility often caused by mild compression or irritation of the mandibular nerve. This typically resolves within weeks or months, but in severe cases, recovery might take longer. Permanent loss of sensation can occur, indicating significant nerve damage and lasting effects on touch, temperature, or pain perception.

Conclusions

Various treatments exist for nerve damage, including low-level laser therapy, pain management medications, or physical therapy. While these therapies may improve neurosensory impairment, patients often report a decline in their quality of life.

Shedding Light on Perioperative Nerve Injury: An Investigation Using the SHED (Symptoms Categorization-History Taking-Examination-Diagnostic Evaluations) Approach

Peripheral nerve blocks (PNBs) provide analgesia and anesthesia in diverse surgical procedures. Despite their recognized benefits, the occurrence of complications, particularly peripheral nerve injuries (PNIs), is a noteworthy concern. Prompt identification and intervention for perioperative nerve injuries are crucial to prevent permanent neurological impairment. A meticulous, systematic evaluation centered on the onset and progression of symptoms becomes imperative. The SHED (symptoms categorization-history taking-examination-diagnostic evaluations) approach serves as a valuable tool for diagnosing causative factors, determining the type of nerve injury, and formulating an effective treatment plan to mitigate further harm. This case report employs the SHED approach to elucidate a perplexing instance of PNIs. The patient, experiencing neurological symptoms post-forearm surgery under a PNB, serves as a focal point. The report underscores the significance of a systematic, stepwise approach in managing patients with suspected PNIs. Vigilant patient monitoring, collaborative teamwork, shared responsibilities, and consideration of potential contributing factors beyond the nerve block are highlighted for an accurate diagnosis and effective treatment of PNIs. The aim is to guide healthcare professionals in navigating similar clinical scenarios, ultimately ensuring patient safety and optimizing outcomes.