How Many Oral Surgeons Does It Take to Classify a Nerve Injury?

Abstract

There is inconsistency in clinical grading of peripheral trigeminal nerve (TN5) injuries that impact patient care. The study goal is to assess the current status of evaluation and classification of TN5 injuries by oral and maxillofacial surgeons (OMSs). A cross-sectional study design used an electronic survey to 100 selected OMSs to determine their clinical TN5 injury practice, including neurosensory testing, confidence level with current protocols, and evaluation and treatment of a hypothetical TN5 injury case. The target sample was enhanced to reduce type 2 error, assuming prior experience in the diagnosis and management of TN5 injuries. The sample was composed of 90 respondents. Nerve injury classification systems used by OMSs include Seddon (44%), Sunderland (70%), and Medical Research Council Scale (31%). Neurosensory testing protocols varied considerably among survey respondents. A sample case for Medical Research Council Scale grading produced inconsistent and inaccurate results. There was no consensus on TN5 injury management, and recommendations for timely nerve repair varied from 1month to up to 1year after injury. Half of the respondents stated that OMSs are not adequately prepared to assess inferior alveolar/lingual nerve injuries, and most oral-maxillofacial surgery respondents evaluate fewer than 10 TN5 injuries each year. Most OMSs (92%) have had a temporary inferior alveolar/lingual nerve injury, while 54% have had a permanent injury; of which, 21% required microsurgical repair. The majority of OMSs (74%) believed that a uniform TN5 injury classification system is needed. Within the oral-maxillofacial surgery target group experienced in evaluation of TN5 injuries, respondents do not feel confident in the assessment of these injuries. There is inconsistency in evaluation methods, and there is agreement that a unified classification system is needed for more efficient patient evaluation and reporting of outcomes in the literature. The Medical Research Council Scale and clinical neurosensory testing is preferred for evaluation of TN5 injuries.