Lingual Nerve Damage Research Articles

A Patient-Specific 3D Printed Lingual Nerve Protector in Third Molar Extraction.

We present a novel, patient-specific 3D-printed lingual nerve protector designed to minimize the risk of nerve injury during mandibular third molar extraction, a common cause of lingual nerve damage. Lingual nerve injuries, often resulting from trauma, dental procedures, or maxillofacial surgeries, lead to significant functional impairments. Using computed tomography (CT) data, the custom protector is fabricated through 3D printing with a self-retaining structure to shield the lingual mucosa and nerve. The device effectively separates the lingual nerve from the surgical field without requiring retraction of the lingual flap, thereby reducing the risk of nerve injury and enhancing the safety and ease of the procedure.

Assessment of the Impact of Different Surgical Techniques on Nerve Function and Sensation after Maxillofacial Surgery.

One potential long-term side effect of surgery in the oral and maxillofacial region is neurosensory impairment. Due to their physical proximity to the surgical location, the lingual nerve (LN) and inferior alveolar nerve (IAN), two sensory segments of the trigeminal nerve, are always susceptible to damage during third molar extraction. Assessment of the impact of different surgical techniques on nerve function and sensation after maxillofacial surgery. There was retrieval of information from medical records of study participants regarding the presence of symptoms like paresthesia, numbness, loss of sensation in lower lip, difficulty in movement of tongue, and all other findings observed after 7 days of surgical procedures. Clinically neurosensory examinations were utilized to assess nerve damage. Pinprick testing and the two-point discrimination test were used. Seven male patients were found to have damage to LN while nine males suffered damage to trigeminal nerve. 12 female patients were found to have damage to LN while 16 females suffered damage to trigeminal nerve. In total 19 patients suffered damage to LN while 25 patients suffered damage to trigeminal nerve. The incidence of LN damage was 9.5%, and the incidence of trigeminal nerve damage was 12.5%.

Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review.

This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022. Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage.

Incidence of lingual nerve damage following surgical extraction of mandibular third molars with lingual flap retraction: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to examine more recent data to determine the extent of lingual nerve injury (LNI) following the surgical extraction of mandibular third molars (M3M). A systematic search of three databases [PubMed, Web of Science and OVID] was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria encompassed studies on patients who underwent surgical M3M extraction using the buccal approach without lingual flap retraction (BA-), buccal approach with lingual flap retraction (BA+), and lingual split technique (LS). The outcome measures expressed in LNI count were converted to risk ratios (RR). Twenty-seven studies were included in the systematic review, nine were eligible for meta-analysis. Combined RR for LNI (BA+ versus BA-) was 4.80 [95% Confidence Interval:3.28-7.02; P<0.00001]. The prevalence of permanent LNI following BA-, BA+ and LS (mean%±SD%) was 0.18±0.38, 0.07±0.21, and 0.28±0.48 respectively. This study concluded that there was an increased risk of temporary LNI following M3M surgical extractions using BA+ and LS. There was insufficient evidence to determine whether there is a significant advantage of BA+ or LS in reducing permanent LNI risk. Operators should use lingual retraction with caution due to the increased temporary LNI risk.

Lingual nerve injury during extraction of mandibular third molars: Are we extracting correctly?

Introduction: Neurological injuries including lingual nerve damage are among the most devastating complications of mandibular third molar extraction. Various causes of lingual nerve damage have been proposed in literature including the surgical technique.&#x0D; Objective: This study aims to assess the adverse outcomes of the removal of mandibular third molars in terms of the frequency of lingual nerve injury (LNI).&#x0D; Methodology: This prospective case series was carried out at Maroof International Hospital, Islamabad. Surgical extraction was performed after raising both lingual and buccal mucoperiosteal flaps for surgical access. Ostectomy and tooth sectioning was performed while protecting the lingual flap with a passively placed periosteal elevator. Patients were recalled for the assessment of lingual nerve status, one week postoperatively. &#x0D; Results: Out of the total of 1487 teeth extracted temporary lingual nerve injury was observed in just two cases (0.13%) both of which were extracted because of recurrent pericoronitis. None of the patients had a permanent neurological deficit. &#x0D; Conclusion: For improving civility in nursing college, insight into incivility among students and faculty members is to be developed and policies to be in place to address unacceptable behaviors in a timely and effective manner. A surgical technique using careful lingual flap elevation and passive retraction results in the prevention of iatrogenic lingual nerve injury.

21. An assessment of Inferior Dental (IDN) and Lingual Nerve (LN) injuries following third molar removal under LA, IVS, and GA – An audit and case-series

Neurosensory deficits following third molar removal affect the quality of life markedly. The purpose of this audit was to evaluate the incidence of IDN and LN damage and to compare departmental rates to an established standard.

A distressing numbness of the tongue: lingual nerve damage following surgical removal of lower wisdom tooth

article: A distressing numbness of the tongue: lingual nerve damage following surgical removal of lower wisdom tooth - European Journal of Oral and Maxillofacial Surgery 2021 December;5(3):91-4 - Minerva Medica - Journals

Frequency of Lingual Nerve Damage during Surgical Removal of Impacted 3rd Molar

Introduction: Professional skills, training and experience is mandatory for removing impacted 3rd molars with aid of local/general anesthesia, sedation. As for symptomatic 3rd molars decision for removing is not difficult usually, but for removing asymptomatic 3rd molars decision is less clear &amp; requiring good clinical experience. Objective: The objective this study was to determine frequency of lingual nerve damage during surgical removal of impacted 3rd molar Design: Descriptive cases series Study Setting: This study was conducted at Department of Oral and Maxillofacial Surgery, Sandeman Provincial Hospital Quetta over 6 months (April 10, 2018 till Oct 10, 2018). Materials and Methods: All 149 cases after approval of hospital ethical committee fulfilling the inclusion criteria were included in this study. After clinical and radiographic diagnosis of affected tooth like depth, position or any other difficulty, the surgical procedure was selected. An impacted tooth was labeled when it was failed to explode into the dental arch within the expected developmental window. After operation surgical sites of all patients were reviewed by the same consultant after 7 days. It was instructed to all patients that report any problem in lingual sensation; by clinical examination sensory deficits were recognized bilaterally. Results: The mean age of all cases was 29.82 ± 6.81 years with minimum and maximum age of 18 and 40 years. There were 83(55.7%) male and 66(44.3%) were females. According to types of impaction 22(14.8%) cases had Mesioangular, 10(6.7%) had Horizontal, 12(8.1%) had Vertical, 17(11.4%) had Distoangular, 14(9.4%) had Class I, 15(10.1%) had Class II, 11(7.4%) had Class III, 14(9.4%) had Class A, 16(10.7%) had Class B and 18(12.1%) cases had Class C. A total of 16(10.7%) cases had inguinal injury in this study. Conclusion: This study concludes that 10.7% cases had inguinal injury in this study. So, this procedure of impacted mandibular third molar is associated with minor but expected complications like the lingual nerve damage. Hence, preoperative and intraoperative consideration must be taken up to reduce this preventable complication. Keywords: Impacted teat, 3rd molar, surgery, complications, lingual nerve damage

Preoperative visualization of the lingual nerve by 3D double-echo steady-state MRI in surgical third molar extraction treatment

ObjectivesTo assess the lingual nerve (LN) visualization using a 3D double-echo steady-state MRI sequence (3D-DESS).Materials and methodsThree readers prospectively evaluated the LN for its continuous visibility in 3D-DESS MRI in 19 patients with an indication for removal of mandibular impacted third molars, using a 5-point scale (4 = excellent to 0 = none). Six LN anatomical intermediate points (IP) were selected and checked for their detectability by a 4-point scale (4 = yes to1 = no). Inter- and intra-rater agreement was evaluated using intraclass correlation coefficient and percentage of agreement.ResultsThe average nerve continuity score was 3.3 ± 0.46. In 35% of the cases, the entire course was continuously visible. In 10%, the proximal and 60%, the distal part of the nerve was not continuously visible. Inter- and intra-reader agreement was good (ICC = 0.76, ICC = 0.75). The average detectability score of all IP was 3.7 ± 0.41. From IP1 to IP5, the detectability was excellent; meanwhile, IP6 had lower visibility. The inter- and intra-reader percentage of agreement was 77% and 87%.ConclusionsThe 3D-DESS sequence allowed accurate and continuous visualization of the LN with high reproducibility in more than one-third of the patients. This could improve the preoperative clarification of the LN position and thereby reduce complications during dentoalveolar surgical interventions.Clinical relevance3D-DESS MRI might be beneficial in clinical scenarios where the second molar is elongated or presents a difficult rotational position while simultaneously having a close positional relationship to the third molar. Thereby, osteotomy performed more lingually, indicating extended lingual flap detachment may increase the risk of LN damage.

Does the Coronectomy a Feasible and Safe Procedure to Avoid the Inferior Alveolar Nerve Injury during Third Molars Extractions? A Systematic Review.

This systematic review aimed to review the literature on the coronectomy technique and evaluate the incidence of success and complications as a surgical approach for inferior third molars. Online databases were searched for data on the frequency of inferior alveolar nerve damage, lingual nerve damage, root migration, pain, infection, dry socket, and extraction of the remaining root, and data on the necessity of reintervention were also extracted. Randomized clinical trials, controlled clinical trials, prospective cohort studies, and prospective and retrospective studies with or without the control group were intercepted. This systematic review was registered in PROSPERO (CDR 42020135485). Sixteen papers analyzed 2176 coronectomies in total, and only five of them were judged as appropriate according to methodological quality assessment. The incidence of inferior alveolar nerve injury was documented in 0.59% of the procedures, lingual nerve injury in 0.22%, infection 3.95%, dry socket 1.12%, extraction of the root 5.28%, and reintervention 1.13%. The pain was the most reported, in 22.04% of the population. This study provides an overview of the clinical success and complications of coronectomy, and their prevalence. A coronectomy may be considered a low-risk procedure and an option for treatment to avoid potential damage to nervous structures. However, patients should still undergo a full screening and evaluation of postsurgical procedures.

Mandibular third molar surgery: A review of common and uncommon complications

Background: Third molar surgical extraction is one of the commonest surgical procedures in oral surgery and it is associated with postoperative complications. However, some of these complications are commoner than others and they have variable impacts on the quality of life of the patients.Objective: To review the common and uncommon complications of third molar surgery as reported in the literature.Methods: PubMed, ScienceDirect databases, AJOL, and Google scholar literature search was done to identify related articles on complications of mandibular third molar surgical extractions. Other online materials were also reviewed. The search words used were mandibular, third molar, lower jaw, surgical extraction, common, uncommon, and complicationsResults: Common complications of third molar surgery identified include; postoperative pain, swelling, trismus, infection, dry socket, inferior alveolar and lingual nerve damage, injury to the adjacent tooth, with their attendant impact on the patient’s quality of life.Conclusion: Third molar surgical extractions are associated with certain complications and some of them are unavoidable. Therefore, adequate patients’ education and psychological preparation for the procedure and its sequelae are necessary.

Analysis of complications after the removal of 339 third molars.

Extractions of third molars constitute about 90% of the scheduled surgical procedures performed by oral surgeons. Wisdom tooth surgery is associated with complications, such as the lingual and inferior alveolar nerve damage, bleeding, tooth/jaw fractures, tooth displacement into the adjacent anatomical spaces, trismus, infections, and other. The aim of the study was to analyze complications after wisdom tooth extraction in patients treated at the Department of Oral Surgery of Jagiellonian University Medical College in Kraków, Poland, in the years 2016-2018. A retrospective analysis of the medical records of 339 patients treated in the outpatient setting was performed. The inclusion criterion comprised a single extraction of a third molar. The exclusion criteria were multiple extractions, comorbidities and pregnancy. No antibiotic prophylaxis was used. The incidence of post-extraction complications, such as oroantral communication, postoperative hematoma, acute inflammation of the surrounding tissues, trismus, and transient paresthesia in relation to patient gender and age, the developmental stage and location of the removed tooth as well as the type of surgery were studied. Perioperative complications occurred in 51 (15.0%) cases, and comprised the acute inflammation of the surrounding tissues in 31 patients, trismus after the removal of 13 lower third molars, oroantral communication after the extraction of 5 upper wisdom teeth, and hematoma as well as a transient sensory alteration of the lingual nerve in 1 case each. Complications were more common in patients who had a surgical extraction of a wisdom tooth with root separation and in cases of lower third molar extractions. No statistically significant correlation was found between the patients' age or gender, the developmental stage of the extracted tooth and the number of observed complications. Lower third molars and the necessity of surgical extraction with root separation are risk factors for postoperative complications in patients who require wisdom tooth removal. Complications after the removal of third molars are most often inflammatory.

Anatomical Risk Factors of Inferior Alveolar Nerve Injury Association with Surgical Extraction of Mandibular Third Molar in Korean Population

The purpose of this study was to analyze the incidence and risk factors of possible inferior alveolar nerve (IAN) injury after extraction of the mandibular third molars. A total of 6182 patients were examined for 10,310 mandibular third molar teeth. Panoramic radiography and patients’ medical records were used to analyze age, gender, and impaction pattern of the mandibular third molar. Cone beam computed tomography (CBCT) was used to investigate the detailed pathway of the inferior alveolar nerve and evaluated the presence of symptoms of nerve damage after tooth extraction. In CBCT, 6283 cases (61%) of the inferior alveolar nerve were actually in contact with the root of the mandibular third molar. The correlation with the panoramic signs of root darkening (p &lt; 0.001), root deflection (p &lt; 0.001), interruption of the IAN (p &lt; 0.001), diversion of the IAN (p &lt; 0.001), and narrowing of the IAN (p &lt; 0.001) had statistical significance. Of the 4708 patients who underwent surgical extraction, 31 (0.658%) complained of nerve damage. Among them, 30 patients (0.637%) complained of symptoms of inferior alveolar nerve damage, and 1 patient (0.02%) complained of symptoms of lingual nerve damage. There was a significant correlation with IAN injury in cases where the roots became dark at the IAN area (p = 0.018) and there was diversion of the IAN at the root area (p = 0.041). When the narrowing of the IAN and the lingual driving pathway of the inferior alveolar nerve appeared simultaneously in CBCT, the risk of IAN injury was high.

Modified Marionette Technique for Unassisted In-Office Access to the Submandibular Duct.

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Robot-assisted sialolithotomy with sialoendoscopy: a review of safety, efficacy and cost.

Review the safety, efficacy and cost of robot-assisted sialolithotomy with sialoendoscopy (RASS) for large submandibular gland hilar sialoliths. Retrospective case series. Patients ≥18 years diagnosed with submandibular hilar sialolithiasis between 1/1/2015 and 7/31/2018 who underwent RASS were identified. Procedure success, post-operative complications, procedure duration, and costs associated with the procedure were reviewed. 33 patients fit inclusion criteria. 94% of patients had successful sialolith removal. Mean sialolith size was 8.9 mm. 15.1% had transient tongue paresthesia. 0% had permanent tongue paresthesia compared to a 2% rate of lingual nerve damage cited in the literature for combined approach sialolithotomy (CAS). The average total cost was $16,921. Insurance paid 100%, 90-99%, 70-89.9%, and 40-69.9% of the expected reimbursement in 43.8%, 18.7%, 18.7% and 12.5% of patients respectively. 6% of patients self-paid. Compared to CAS, the cost of reusable robotic arms and drapes totaled $475, though these costs were included in the standardized operative cost per minute and were not forwarded to the patient. The mean procedure time was 62 minutes. Compared to published mean procedure times for CAS, the reduced operative time may account for a savings of $3332-$6069. RASS is a safe modality for submandibular hilar sialolith removal with a high success rate, low risk for temporary tongue paresthesia, and lower rate of permeant lingual nerve damage compared to CAS. Compared with CAS, RASS may result in a net reduction of operative room costs given its shorter procedure time.

Current perspectives on the surgical management of mandibular third molars in the United Kingdom: the need for further research.

This survey of expert opinion regarding the management of mandibular third molar (M3M) impaction and its clinical sequelae was circulated to all members of the British Association of Oral and Maxillofacial Surgeons (BAOMS). It was completed by 289 clinicians who reported treating 60003 patients annually. Respondents included 199 (69%) specialists and 58 (20%) primary care clinicians. Most (99%) of the clinicians treated at least one M3M with complete surgical removal (CSR) annually. Only 69% performed one or more coronectomies (COR). Advocates of coronectomy reported lower rates of inferior alveolar nerve (IAN) injury, but IAN, lingual nerve, and adjacent second molar damage were rare, occurring in less than 0.5% of cases, with small differences between the COR and CSR groups. Although these differences are not statistically significant, they are likely to be clinically important. Also, the COR group would have comprised mainly high-risk teeth, while the CSR group would include many teeth at low risk of complications. This might have skewed the results. Those clinicians performing no coronectomies cited three main reasons for being low adopters of COR: the lack of irrefutable evidence to support its benefit, the increased need for a second operation, and more non-IAN complications. Although COR may prevent permanent IAN damage in high-risk cases, this paper highlights clinicians' views that there is a gap in evidence and knowledge to support COR. As a result, 47% of the clinicians surveyed recommended, and were prepared to participate in, further studies to determine the effectiveness and safety of COR.

Dentoalveolar Surgery Articles

Resnick CM, Calabrese CE, Afshar S, Padwa BL: Do oral and maxillofacial surgeons over-prescribe opioids after extraction of asymptomatic third molars? J Oral Maxillofac Surg 77:1332, 2019 Nicolatou-Galitis O, Schiødt M, Mendes RA, et al: Medication-related osteonecrosis of the jaw: Definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol 127:117, 2019 Otto S, Pautke C, Van den Wyngaert T, et al: Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases. Cancer Treat Rev 69:177, 2018 Schmitt CM, Buchbender M, Musazada S, et al: Evaluation of staff satisfaction after implementation of a surgical safety checklist in the ambulatory of an oral and maxillofacial surgery department and its impact on patient safety. J Oral Maxillofac Surg 76:1616, 2018 Pippi R, Spota A, Santoro M: Medicolegal considerations involving iatrogenic lingual nerve damage. J Oral Maxillofac Surg 76:1651.e1, 2018 Geisler BP, Ji YD, Peacock ZS: Value in oral and maxillofacial surgery: A systematic review of economic analyses. J Oral Maxillofac Surg 75:2287, 2017 Ferneini EM, Goldberg MH: Management of oral and maxillofacial infections. J Oral Maxillofac Surg 76:469, 2017 Cheng KL, Dodson TB, Egbert MA, Susarla SM: Which factors affect citation rates in the oral and maxillofacial surgery literature? J Oral Maxillofac Surg 75:1313, 2017 Dennis MJ, Bennett JD, DeLuke DM, et al: Improving the medical curriculum in predoctoral dental education: Recommendations from the American Association of Oral and Maxillofacial Surgeons committee on predoctoral education and training. J Oral Maxillofac Surg 75:240, 2017 Reiland MD, Ettinger KS, Lohse CM, Viozzi CF: Does administration of oral versus intravenous antibiotics for third molar removal have an effect on the incidence of alveolar osteitis or postoperative surgical site infections? J Oral Maxillofac Surg 75:1801, 2017 Bouloux GF, Busaidy KF, Beirne OR, et al: What is the risk of future extraction of asymptomatic third molars? A systematic review. J Oral Maxillofac Surg 73:806, 2015

Neurological complications and quality of life after submandibular gland resection. A Prospective, non-randomized, single-centre study.

There are different complications related to the submandibular gland resection, like damage to the mandibular branch of the facial nerve, lingual or hypoglossal nerve. Moreover, subjective complaints like dry mouth, altered sensation around the scar and taste alterations were described. A prospective, non-randomized study was performed including 20 patients treated with submandibular gland resection. The most common etiology was sialolithiasis affecting 9 (45%) patients. One (5%) patient presented a lingual nerve paresis, 2 (10%) patients presented a transient marginal mandibular branch paresis and no hypoglossal nerve alteration was observed. Factors like the size of the lithiasis (P = 0.293), size of the tumor (P = 0.445) or type of pathology (P = 0.694) were not related with neurological complications. Altered sensation in the skin around a scar was the most severely weighted problem (55% and 33.3%), and xerostomia was the second one (33% and 27.3%) at one month and at six months after surgery, respectively. The submandibular gland resection remains to be a safe technique with a low rate of surgical and neurological complications. However, patients should be informed about sequelae like xerostomia, altered sensation in the skin or pain around the scar, which may be discomforting. The cosmetic result can be satisfactory, but a surgical scar can be avoided with another approach. Although rare, the risk of MBFN, lingual and hypoglossal nerve damage should always be included in the preoperative information on surgical risks.

Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach

The conservative transoral approach to hilo-parenchymal submandibular stones has been proposed as an alternative to traditional sialadenectomy. The main purpose is to preserve the gland and eliminate the risk of a cervical scar and damage to the marginal mandibular branch of the facial nerve. The spread of transoral robotic surgery has favoured its application not only in the oropharynx, but also in the anterior oral cavity. This article describes a transoral robotic approach for hilo-parenchymal submandibular stones. In January 2019, two patients with a right and a left hilo-parenchymal submandibular stone of 15mm and 8mm, respectively, underwent removal of the stone with transoral robotic surgery using the Si Da Vinci surgical robot. The procedure was performed successfully and tolerated well, with a one-night hospitalization. There were no complications such as lingual nerve damage, painful gland swelling, infection, or ranula. The patients were followed up clinically and ultrasonographically for the first 3 months to verify symptom relief and persistence of stones; no symptoms or stones were found. The transoral robotic surgical approach seems to be safe and adequate for the conservative management of large hilo-parenchymal submandibular stones. An adequate diagnosis together with proper docking and an appropriate approach to the oral floor is mandatory.

Does articaine, rather than lidocaine, increase the risk of nerve damage when administered for inferior alveolar nerve blocks in patients undergoing local anaesthesia for dental treatment? A mini systematic review of the literature.

This mini systematic review seeks to analyse the available literature and determine if a 4% articaine solution poses a greater risk of inferior alveolar and/or lingual nerve damage compared to that of 2% lidocaine, when administered for an inferior alveolar nerve block. After a mini systematic review of the published literature, seven suitable studies were identified: one double-blind random controlled trial (DBRCT) and six retrospective cohort studies. The DBRCT and two of the cohort studies concluded that 4% articaine poses no greater risk of nerve damage. The remaining four cohort studies suggested that caution should be exhibited when using a 4% local anaesthetic solution rather than a 2% solution. However, these studies also concluded that no evidence exists to explain the reasons for their results. The included articles present no conclusive evidence to suggest that 4% articaine causes more nerve damage than 2% lidocaine, although some authors advise caution when using this agent. All studies conclude that further quality research is required, and it is therefore suggested that dental practitioners exhibit caution when choosing to use 4% articaine in an inferior alveolar nerve block until further scientific research has been performed.