Surgeon versus patient assessment of neurosensory function after lingual nerve repair

Abstract

Statement of the Problem: The purpose of this study was to examine the relationship between the surgeon’s objective assessment and the patient’s perception of neurosensory function one year after lingual nerve repair. Materials and Methods: This was a retrospective cohort study consisting of subjects who underwent lingual nerve repair at the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery between July 2000 and October 2002. The predictor variable was change in neurosensory test results between the pre- and one-year postoperative evaluations. Neurosensory status was assessed as described by Zuniga et al and scored as follows: Normal sensation = 4, Level A = 3, B = 2, C = 1, anesthesia = 0.1 A positive difference in pre- and postoperative scores indicates an improvement in neurosensory function. The primary outcome variable was subject self-report of satisfaction ranging from poor (poor = 1) to excellent (excellent = 5). The secondary outcome variable was the Oral Health Impact Profile (OHIP) score measured one-year postoperatively. OHIP is a 14-item questionnaire designed to measure self-reported dysfunction and disability associated with oral health conditions, eg, trouble pronouncing words or painful aching. Each element is scored from 1 (poor) to 5 (excellent). OHIP scores can range from 14 to 70 with lower scores associated with greater dysfunction and disability. Method of Data Analysis: Data pertaining to predictor and outcome variables were entered into a statistical database (SPSS v11.0; SPSS Inc) over the course of the study. Bivariate Pearson correlations were computed for each predictor variable versus the outcome variables. A P value < .05 was considered statistically significant. Results: The sample was composed of 13 subjects (9 female, 12 Caucasian) with a mean age of 25.6 ± 6.9 years at the time of operation. The neurosensory functional measure improved an average of one score level, 1.2 ± 1.0 (range: −1 to 3), between the pre- and postoperative assessments. For example, subjects who were anesthetic preoperatively (score = 0) were scored as having Level C (score = 1) sensation one year postoperatively. Sixty-two percent of subjects (62%) ranked their satisfaction with the operative result as good to excellent. There was a statistically significant, positive correlation between changes in measured neurosensory status and patient satisfaction (r = 0.81, P < .01). The mean OHIP score was 31.3 plus/minus 12.5 (range: 16 to 64). Neither perioperative changes in neurosensory status (r = −0.37, P = .21) nor objective neurosensory scores measured one-year postoperatively (r = −0.28, P = .35) were statistically significantly associated with the OHIP score. Conclusion: There is a strong, statistically significant correlation between the surgeon’s objective measure of postoperative improvement and patient satisfaction with neurosensory function after lingual nerve repair. There was not an association between objective measures of neurosensory score and subject self-report of dysfunction or disability. References Zuniga JR, Essick GK: A contemporary approach to the clinical evaluation of trigeminal nerve injuries. Oral Maxillofac Clin North Am 4:353, 1992 Lam NP, Donoff RB, Kaban LB, et al: Patient satisfaction after trigeminal nerve repair. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95:538, 2003 Funding Source: NIDCR Mid-Career Award in Patient Oriented Research #K24-DE000448 (T.B.D.); Massachusetts General Hospital Department of Oral and Maxillofacial Surgery Education and Research Fund (S.M.S., T.B.D.).