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Asociación Mexicana de Cirugía Bucal y Maxilofacial, Colegio Mexicano de Cirugía Bucal y Maxilofacial, A.C.

2024, Number 3

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Rev Mex Cir Bucal Maxilofac 2024; 20 (3)

Injuries to the inferior alveolar nerve and lingual nerve associated with surgical extraction of the lower third molar

Patlán VEA, Cadena AJL, Rodríguez GCS, Tapia PDC, Hernández ZDP

Language: Spanish
References: 30
Page: 105-114
PDF size: 491.45 Kb.


ABSTRACT

Introduction: injuries to the inferior alveolar and lingual nerve are complications that can be associated with the extraction of the lower third molar. These complications may negatively impact the style and life quality of affected patients. Objectives: determine the incidence of nerve injuries associated with lower third molar surgery and its relationship with different variables in a group of Mexican patients. Material and methods: a descriptive and retrospective study of nerve injuries presented in the Maxillofacial Surgery service of a concentration hospital in the State of Mexico was carried out. Results: out of 357 lower third molar surgeries performed in 325 patients, there were five cases of patients with nerve injuries (1.53%). It was identified that 100% of these lesions corresponded to the inferior alveolar nerve, presented clinically as paresthesia. Four lesions (80%) remitted before three months and one lesion (20%) prevailed for more than six months. Four female patients (80%) and one male (20%), aged between 20 and 45 years, were affected. Radiographic signs found included darkening of the root in three cases (60%) and interruption of the white line in two cases (40%) associated with third molars in different positions, according to the Winter and Pell & Gregory classifications. Conclusions: the incidence of this complication is low in patients treated in a specialized service, where the lesions of the inferior alveolar nerve, reversible and clinically manifested with paresthesia were predominated. The radiographic signs described in the literature can be risk predictors of nerve injuries.


REFERENCES

  1. Synan W, Stein K. Management of impacted third molars. Oral Maxillofac Surg Clin North Am. 2020; 32 (4): 519-559. Available in: https://www.sciencedirect.com/science/article/abs/pii/S104236992030056X?via%3Dihub

  2. Bouloux GF, Steed MB, Perciaccante VJ. Complications of third molar surgery. Oral Maxillofac Surg Clin North Am. 2007; 19 (1): 117-128. Available in: https://www.sciencedirect.com/science/article/pii/S1042369906001130?via%3Dihub

  3. Marciani RD. Complications of third molar surgery and their management. Atlas Oral Maxillofac Surg Clin. 2012; 20 (2): 233-251.

  4. Kaleem A, Amailuk P, Hatoum H, Tursun R. The Trigeminal nerve injury. Oral Maxillofac Surg Clin North Am. 2020; 32 (4): 675-687.

  5. Auyong TG, Le A. Dentoalveolar nerve injury. Oral Maxillofac Surg Clin North Am. 2011; 23 (3): 395-400.

  6. Markiewicz MR, Callahan N, Miloro M. Management of traumatic trigeminal and facial nerve injuries. Oral Maxillofac Surg Clin North Am. 2021; 33 (3): 381-405.

  7. Meyer RA, Bagheri SC. Nerve injuries from mandibular third molar removal. Atlas Oral Maxillofac Surg Clin North Am. 2011; 19 (1): 63-78.

  8. Miloro M, Kolokythas A. Management of complications. Oral and Maxillofacial Surgery. S.L.: Wiley-Blackwell; 2022, pp. 35-37.

  9. LaBlanc J. Classification of nerve injuries. Oral and Maxillofacial Surgery Clinics of North America 1992; 4: 285-296. Disponible en: https://www.oralmaxsurgery.theclinics.com/article/S1042-3699(20)30589-6/abstract

  10. Ziccardi VB, Zuniga JR. Nerve injuries after third molar removal. Oral Maxillofac Surg Clin North Am. 2007; 19 (1): 105-15, vii.

  11. On SW, Cho SW, Byun SH, Yang BE. Clinical significance of intraoperative exposure of inferior alveolar nerve during surgical extraction of the mandibular third molar in nerve injury. J Clin Med. 2021; 10 (19): 4379.

  12. Renton T, Yilmaz Z, Gaballah K. Evaluation of trigeminal nerve injuries in relation to third molar surgery in a prospective patient cohort. Recommendations for prevention. Int J Oral Maxillofac Surg. 2012; 41 (12): 1509-1518.

  13. Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990; 28 (1): 20-25.

  14. Lacerda-Santos JT, Granja GL, Catão MHCV, Araújo FF, Freitas GB, Araújo-Filho JCWP, Freire JCP, Dias-Ribeiro E, Santos JA. Signs of the proximity of third molar roots to the mandibular canal: an observational study in panoramic radiographs. Gen Dent. 2020; 68 (2): 30-35.

  15. Seddon HJ. Three types of nerve injury. Brain. 1943; 66: 237-288.

  16. Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951; 74: 491-516.

  17. Mackinnon S, Dellon AL. Diagnosis of nerve injury. Surgery of the peripheral nerve. NY: Thieme 1988.

  18. Steed MB. Peripheral nerve response to injury. Atlas Oral Maxillofac Surg Clin North Am. 2011; 19 (1): 1-13.

  19. Meyer RA, Bagheri SC. Clinical evaluation of peripheral trigeminal nerve injuries. Atlas Oral Maxillofac Surg Clin North Am. 2011; 19 (1): 15-33.

  20. Ghali GE, Epker BN. Clinical neurosensory testing: practical applications. J Oral Maxillofac Surg. 1989; 47 (10): 1074-1078.

  21. Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF. The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg. 1998; 56 (1): 2-8.

  22. Miloro M, Kolokythas A. Inferior alveolar and lingual nerve imaging. Atlas Oral Maxillofac Surg Clin North Am. 2011; 19 (1): 35-46.

  23. Haug RH, Abdul-Majid J, Blakey GH, White RP. Evidenced-based decision making: the third molar. Dent Clin North Am. 2009; 53 (1): 77-96, ix.

  24. Winter GB. Principles of exodontias as applied to the impacted mandibular third molar. S.L.: American Medical Book. 1926.

  25. Pell GJ, Gregory BT. Impacted mandibular third molars classification and modified technique for removal. Dental Dig. 1933; 39: 330-338.

  26. Rieder M, Remschmidt B, Schrempf V, Schwaiger M, Jakse N, Kirnbauer B. Neurosensory deficits of the mandibular nerve following extraction of impacted lower third molars-a retrospective study. J Clin Med. 2023; 12 (24): 7661.

  27. Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH. Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases. Int J Oral Maxillofac Surg. 2010; 39 (4): 320-326.

  28. Chai Y, Dong Y, Lu Y, Wei W, Chen M, Yang C. Risk factors associated with inferior alveolar nerve injury after extraction of impacted lower mandibular third molars: a prospective cohort study. J Oral Maxillofac Surg. 2024; 82 (9): 1100-1108.

  29. Núcleo CMP FORTE - PLM [Internet]. Medicamentosplm.com. 2024 [cited 2024 Oct 1]. Available from: https://www.medicamentosplm.com/Home/productos/nucleo.cmp.forte.capsulas/1018/101/9017/14

  30. Miloro M, Springer-Verlag Gmbh. Trigeminal nerve injuries. Berlin Springer Berlin Springer; 2016, 82, 219, 309.




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