Lingual Nerve Research Articles

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.

Effects of Peripheral Nerve Injury on the Induction of c-Fos and Phosphorylated ERK in the Brainstem Trigeminal Sensory Nuclear Complex.

Sequential changes in brainstem and spinal cord neurons after traumatic injury to peripheral nerves are related to neuropathic pain symptoms. This study was conducted to elucidate the influence of nerve insult on stimulus-induced c-Fos expression and ERK phosphorylation by brainstem neurons. The brainstem trigeminal sensory nuclear complex (BTSNC) was examined for neuronal profiles immunolabeled with c-Fos and phosphorylated ERK (p-ERK) antibodies elicited by stimulation of the tongue with capsaicin after lingual or inferior alveolar nerve (IAN) injury. Abundant neuronal profiles immunolabeled for c-Fos and p-ERK elicited by capsaicin were distributed in the spinal trigeminal nucleus caudalis (Vc) without nerve injury. The spinal trigeminal nucleus oralis (Vo) contained limited numbers of these neuronal profiles after stimulation of the tongue. A significant reduction of these neuronal profiles in the ipsilateral Vc was detected after lingual nerve injury. After IAN injury, an increased number of neuronal profiles immunolabeled for c-Fos elicited by capsaicin was noted, while that of p-ERK was left unchanged in the ipsilateral Vc. On the both sides of the Vo, an increased number of capsaicin-induced neuronal profiles immunolabeled for c-Fos and p-ERK was detected after lingual or IAN injury. Differential effects of lingual or IAN injury on stimulus-induced c-Fos expression and ERK phosphorylation by Vo and Vc neurons may be involved in the complex nature of symptoms of trigeminal neuralgia.

Lingual Nerve Injury During Impacted Mandibular Third Molar Surgery.

To determine the frequency of lingual nerve injury (LNI) during the surgical removal of mandibular third molar and the associated risk factors. Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, from January to June 2021. A total of 121 patients were included in this study who had undergone impacted third molar surgery. Data were collected on a proforma via interview. Patients were followed up after 1 week, 1 month, and 3 months of duration. Frequency of LNI and its association with various surgical procedure steps were determined. This study shows that out of 121 patients, frequency of LNI was found to be 3.3% (n=4). The type of impaction (p=0.047), lingual flap retraction (p<0.001), tooth splitting (p=0.029), and longer duration of surgery were found to be significantly associated with it. The frequency of LNI during mandibular impacted third molar surgery was 3.3% in this study, and significantly associated with horizontal impaction, lingual flap retraction, tooth splitting, and duration of surgery longer than 30 minutes. Lingual nerve injury, Tooth, Impaction, Third molar, Lingual flap retraction, Tooth splitting.

Is Presurgical Pain Intensity Related to Postoperative Recurrence of Post-Traumatic Trigeminal Neuropathic Pain?

Post-traumatic trigeminal neuropathic pain (PTTNp) is a challenging condition to treat, and equally as challenging is the identification of surgical outcome variables to guide treatment. The study purpose was to determine if preoperative pain intensity was related to postoperative recurrence of PTTNp. This retrospective cohort study assessed subjects with preoperative PTTNp of either the lingual or inferior alveolar nerves who underwent elective microneurosurgery at a single institution. Two cohorts were established as follows: No PTTNp at 6months (group 1); presence of PTTNp at 6months (group 2). The primary predictor variable was the preoperative visual analog scale (VAS) score. The primary outcome variable was PTTNp (recurrence or no recurrence at 6months). The demographic and injury characteristics of the groups were compared to assess whether they were similar using Wilcoxon rank analysis. Two-tailed Student's t-test was performed to analyze the difference in preoperative mean VAS scores. Multivariate multiple linear regression models were used to determine the association between the covariates on the outcomes of the primary predictor variable and the primary outcome variable. A P value of <.05 was considered statistically significant. Forty-eight patients were included in the final analysis. There were 20 patients with no pain at 6months and 28 with recurrence at 6months following surgery. There was a significant difference in mean preoperative pain intensity between the two groups (P value .04). The mean preoperative VAS score in group 1 was 6.31 (standard deviation, 2.65), while the mean preoperative VAS score in group 2 was 7.75 (standard deviation, 1.95). Regression analysis showed that one covariate, the type of nerve injured, explained some variability of preoperative VAS score, but by only 16% (P value .005). Regression analysis also showed that two covariates, Sunderland classification and time to surgery, explained some of the variability of PTTNp at 6months, by approximately 30% (P value .001). This study showed that presurgical pain intensity level was related to postoperative recurrence in the surgical treatment of PTTNp. In patients with recurrence, the preoperative pain intensity was higher. Other factors, including time interval from injury to surgery, were also related to recurrence.

The complete anatomy of the lingual nerve: A meta-analysis with implications for oral and maxillofacial surgery.

Lingual nerve (LN) injury during surgical procedures in the third molar region warrants a detailed study of its common pathway and important variations. Therefore, the objective of this study was to analyze and compile the multiple anatomical variations of the LN for use in oral and maxillofacial surgery. It is anticipated that the results of the present meta-analysis may help to minimize the possible complications when performing procedures associated with this anatomical entity. Major online databases such as PubMed, Web of Science, Scopus, Embase were used to gather all relevant studies regarding the LN anatomy. The results were established based on a total of 1665 LNs. The pooled prevalence of the LN being located below the lingual/ alveolar crest was found to be 77.87% (95% CI: 0.00%-100.00%). The LN was located above the lingual/ alveolar crest in 8.21% (95% CI: 4.63%-12.89%) of examined nerves. The most common shape of the LN was established to be round with a prevalence of 40.96% (95% CI: 23.96%-59.06%), followed by oval at 37.98% (95% CI: 23.98%-53.02%) and flat at 25.16% (95% CI: 12.85%-39.77%). In conclusion, we believe that this is the most accurate and up-to-date study regarding the anatomy of the LN. The LN was found to be located below the lingual/alveolar crest in 77.87% of the cases. Furthermore, the LN was found to enter the tongue under the submandibular duct in 68.39% of the cases. Knowledge about the anatomy of the LN is crucial for numerous oral and maxillofacial procedures such as during the extraction of the third molar.

Is Surgical Repair With Nerve Allograft More Cost-Effective Than Non-Surgical Management for Persistent Trigeminal Neuropathy? Initial Assessment With Markov Model

Persistent trigeminal neuropathy (PTN) is associated with high rates of depression, loss of work, and decreased quality of life (QoL). Nerve allograft repair can achieve functional sensory recovery in a predictable manner; however, it bears significant upfront costs. In patients suffering from PTN, is surgical repair with allogeneic nerve graft, when compared to non-surgical therapy, a more cost-effective treatment option? A Markov model was constructed with TreeAge Pro Healthcare 2022 (TreeAge Software, Massachusetts) to estimate the direct and indirect costs for PTN. The model ran for 40years with 1-year-cycles on a 40-year-old model patient with persistent inferior alveolar or lingual nerve injury (S0 to S2+) at 3months without signs of improvement, and without dysesthesia or neuropathic pain (NPP). The 2 treatment arms were surgery with nerve allograft versus non-surgical management. There were 3 disease states, functional sensory recovery (S3 to S4), hypoesthesia/anesthesia (S0 to S2+), and NPP. Direct surgical costs were calculated using the 2022 Medicare Physician Fee Schedule and verified with standard institutional billing practices. Non-surgical treatment direct costs (follow-up, specialist referral, medications, imaging) and indirect costs (QoL, loss of employment) were determined from historical data and the literature. Direct surgical costs for allograft repair were $13,291. State-specific direct costs for hypoesthesia/anesthesia were $2,127.84 per year, and $3,168.24 for NPP per year. State-specific indirect costs included decreased labor force participation, absenteeism, and decreased QoL. Surgical treatment with nerve allograft was more effective and had a lower long-term cost. The incremental cost-effectiveness ratio was -10,751.94, indicating surgical treatment should be utilized based on efficiency and cost. With a willingness-to-pay threshold of $50,000, the net monetary benefits of surgical treatment are $1,158,339 compared to $830,654 for non-surgical treatment. With a standard threshold incremental cost-effectiveness ratio of 50,000, the sensitivity analysis shows that surgical treatment would remain the preferred choice based on efficiency even if surgical costs were doubled. Despite high initial costs of surgical treatment with nerve allograft for PTN, surgical intervention with nerve allograft is a more cost-effective treatment option when compared to non-surgical therapy.

The sublingual branch of the lingual nerve: Anatomical study and suggestion for a new terminology.

The lingual nerve carries somatosensory fibers from the anterior two-thirds of tongue. The parasympathetic preganglionic fibers arising from the chorda tympani also travel with the lingual nerve in the infratemporal fossa to synapse in the submandibular ganglion to innervate the sublingual gland. However, only a few studies have investigated the specific nerve that innervates the sublingual gland and surrounding tissue i.e., the so-called sublingual nerve. Therefore, this study aimed to clarify the anatomy and definition of the sublingual nerves. Thirty sides from formalin fixed cadaveric hemiheads underwent microsurgical dissection of the sublingual nerves. The sublingual nerves were found on all sides and categorized into three branches, i.e., branches to the sublingual gland, branches to the mucosa of the floor of the mouth, and gingival branches. Additionally, branches to the sublingual gland were subcategorized into types I and II based on the origin of the sublingual nerve. We suggest that the lingual nerve branches should be categorized into five branches, i.e., branches to the isthmus of the fauces, sublingual nerves, lingual branches, posterior branch to the submandibular ganglion, and branches to the sublingual ganglion.

Endoscopically-Assisted Percutaneous Trigeminal Rhizotomy for Trigeminal Neuralgia: A Cadaveric Feasibility Study.

Objective Trigeminal neuralgia (TN) is a debilitating syndrome characterized by paroxysmal facial pain in one or more divisions of the trigeminal nerve. The etiology and treatment paradigms are still controversial. The endoscopically-assisted procedure has not yet been described in percutaneous procedures for TN. The aim of this study was to assess the utility and feasibility of endoscopic-assisted percutaneous approaches for trigeminal rhizotomy in TN. Methods This study comprised eight cadaveric sides heads that underwent an endoscopically assisted percutaneous approach using Hakanson's anterior puncture method for targeting the foramen ovale. Results V3 exiting the foramen ovale was easily visualized with the endoscope on all sides. While approaching the foramen ovale, distal branches of V3 such as the lingual and inferior alveolar nerves were first identified as they traveled between the medial and lateral pterygoid muscles. These branches were then traced proximally to the V3 trunk deep to the lateral pterygoid. Large arteries and veins were easily visualized and avoided in the trajectory to the foramen ovale. No gross injury to any neurovascular structure along the course of the needle insertion was identified. Conclusion We found that endoscopic-assisted percutaneous approach to the foramen ovale is feasible and allows for accurate canalization and anatomical identification of the precise location for rhizotomy under direct visualization. Such a procedure, after it is confirmed in patients, could offer a new technique for reducing unsuccessful canalization and could improve outcomes.

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.

A case report of lingual nerve injury after a prolonged laparoscopic cholecystectomy using supraglottic airway device (i-gel®)

BackgroundThis is a case report of postoperative tongue numbness after a prolonged laparoscopic cholecystectomy using i-gel®.Case presentationA female patient 62 years old, ASA physical status II and with weight 72.7 kg, height 159 cm and BMI 28.8 kg/m2 had general anaesthesia using i-gel size 4 as artificial airway; vital data was stable and within normal range all through the surgery, the surgery was complicated due to the presence of intra-abdominal adhesions and the surgery was prolonged to 90 min With the insertion of surgical drains, she mentioned tongue numbness at the tip of the tongue on postoperative day 1, and this was completely resolved 4 weeks later on further follow-up.ConclusionsWe conclude that postoperative tongue numbness is one of the complications that should be highlighted after the i-gel®.

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.

Choosing the optimal mandible position for inferior alveolar nerve block (IANB) using finite element analysis

BackgroundOne of the most popular methods of local anesthesia in dentistry, inferior alveolar nerve block (IANB) involves the blockade of the inferior alveolar nerve (IAN) and lingual nerve (LN) in the pterygomandibular space. Despite the large number of works describing the contents of this space, the spatial displacements of the anatomical structures of this area at different positions of the mandible have not been sufficiently studied. The aim of our study was to study the spatial movements of the IAN and inferior alveolar artery (IAA) at various positions of the mandible using computer simulation and finite element analysis to find the safest way to conduct IANB. Materials and methodsReverse engineering was used to create a model of the cranial base and the mandible based on computed tomography (CT) data obtained from patient N (male, 24 years old), the arteries of the head and neck were designed from the data of multiphase angiography of patient M (female, 61 years old). Masticatory muscles, sphenomandibular ligament, temporomandibular joint and mandibular nerve were modeled in the SolidWorks software package based on an open database of anatomical structures. The finite element grid was generated in the Solidworks software.In the first series of experiments, the displacement of the mandible was modeled along the vertical axis down by 48 mm (maximum opening of the mouth), in the second series, the jaw was displaced vertically by 48 mm with a simultaneous transversal movement of 10 mm, in the third series, the jaw was displaced along the vertical axis down by 34 mm and transversally by 22 mm. ResultsThe largest distance between IAN and IAA was noted in the third series of experiments. The distance between the nerve and the vessel was minimal in the first series, with an open mouth without lateral displacements. ConclusionThe generated computer model opens new possibilities for studying the dynamic anatomy of the pterygomandibular space. The results of this study can be used for further experimental and clinical trials to find the safest approach to the implementation of IANB, as well as applied in the practice of the educational process.

The Parasympathetic Root of the Submandibular Ganglion: A Review.

The submandibular ganglion is a small fusiform-shaped cluster of cell bodies of the parasympathetic nervous system. Parasympathetic innervation of the submandibular gland is not only responsible for the secretion of saliva, but it also plays a main role in the development and regeneration of the gland. The parasympathetic root of the submandibular ganglion or the posterior branch of the lingual nerve to the submandibular ganglion is one of three roots of the submandibular ganglion. Using standard search engines (PubMed, Google), papers in English discussing the anatomy, embryology, variations, and clinical significance of the parasympathetic root of the submandibular ganglion were reviewed.

Unusual Communication between Nerve to Mylohyoid and Lingual Nerve and, its Clinical Significance- A Cadaveric Study

Introduction: The nerve to mylohyoid is a branch of inferior alveolar nerve which arises just above the mandibular foramen. There is occasionally communicating branch between nerve to mylohyoid and lingual nerve. Knowledge of such variations has significance during oral and submandibular surgery. Aim: To detect and describe the existence and occurrence of anatomical variations in the innervation pattern of the nerve to mylohyoid by using the dissection technique. Materials and Methods: An observational study was carried out from January 2022 to April 2022 in a total of 15 embalmed and formalin-fixed cadavers in the Laboratory of Anatomy of SMBT Medical College, Nashik, Maharashtra. The nerve to the mylohyoid and lingual nerve were cleared and observed for any unusual communication between the two, if any. Results: In 13 (86.67%) cadavers, classical (normal) anatomical presentation of the nerve to mylohyoid was observed, whereas, in two male (13.33%) cadavers, the presence of communicating branch between the nerve to mylohyoid and lingual nerve was observed. In both the cadavers, the communicating branch was unilateral, in one cadaver on the right-side, and in the second cadaver same variation was noted on the left-side. Conclusion: The existence of communication between the nerve to mylohyoid and the lingual nerve is thought to be responsible for inadequate mandibular anesthesia. Through this study, surgeons will be aware of this variance, to explain unexpected findings in nerve injury following oral procedures.

Early lingual nerve suture under local anesthesia after wisdom tooth extraction: a case report

Introduction: Lingual nerve injury is one of the operative risks of mandibular wisdom tooth avulsion surgery. The anatomical relationship of the nerve to the medial side of the socket of the mandibular third molar must be known when performing the procedure. When a lesion occurs, the diagnosis may be delayed by the effect of anesthesia. In the case of a complete section, repair can be considered by direct suture of the nerve margins. It is recommended to perform this suture as soon as possible. In most cases, the lingual nerve suture is performed remotely and under general anesthesia. Observation: The case presented here describes the early repair of a lingual nerve transection after avulsion of a mandibular third molar. The procedure has been performed under local anesthesia one day after surgery and consisted of a direct suture using the previous surgical approach. Conclusion: This allows for a simplified treatment of this complication, thus shortening the management time.

The perception and practice of routine lingual flap retraction in lower third molar surgery among oral and maxillofacial surgeons in Nigeria.

Lingual nerve injury is a known complication of mandibular third molar (M3M) surgery, and retraction of the lingual flap is reported to reduce the incidence of this complication. However, there is no global consensus on the routine retraction of lingual flap. The aim of the study was to assess the perception and practice of lingual flap retraction amongst oral and maxillofacial surgeons in Nigeria. This cross-sectional national survey was conducted amongst 122 oral and maxillofacial surgeons in Nigeria from January 2023 to March 2023 using a validated, structured, self-administered questionnaire. The questionnaire had three sections and 14-item questions. Section A consists of the sociodemographic questions, Section B comprises questions on perception towards lingual flap retraction, whereas Section C consists of questions on the practice of lingual flap retraction. These questionnaires were deployed as an online survey and as hard copies. Both qualitative and quantitative data were analysed. A critical probability level (P < 0.05) was used as the cut-off level for statistical significance. Most of the participants (47.6%) belong to the age group of 31-40 years. The male-to-female ratio was 6:1. Only 12 (9.8%) participants had a positive perception towards routine lingual flap retractions following M3M surgery. Perception of lingual flap retraction was found not to be associated with the demographic variables of the participants (P > 0.05). A total of 95 participants (77.9%) did not raise nor retract the lingual flap during lower third molar surgery. The rate of practice of lingual flap retraction during third molar surgery was not influenced by any of the factors studied (P > 0.05). The majority of oral and maxillofacial surgeons in Nigeria do not agree that routine retraction of the lingual flap is necessary to reduce lingual nerve injury and majority, too, do not practice this in their management of impacted lower third molar.

Management of lingual nerve injury: a case report

Management of lingual nerve injury: a case report

Assessment and Correlation of Variation in Lingual Cortical Plate Thickness with Different Angulations of Impacted Mandibular Third Molar Using Cone Beam Computed Tomography in North Indian Population.

The extraction of impacted mandibular third molar is associated with various types of intraoperative and postoperative complications, one of them is injury to lingual nerve. The present study aims to assess and correlate the variation in lingual cortical plate thickness with different angulations and determine the topographic relationship between the root apex of impacted mandibular third molar and lingual cortical plate using Cone Beam Computed Tomography (CBCT). This prospective cohort study enrolled 140 patients with impacted mandibular third molars who underwent preoperative CBCT imaging. The CBCT images were used to evaluate the outcome variables such as lingual cortical plate thickness and topographical relationship between root apex of impacted mandibular third molar and lingual cortical plate. The predictor variables included age, gender, inclination of third molar, mesiodistal angle, buccolingual angle and lingual plate morphology. The temporary lingual nerve paresthesia was reported by 1 patient (0.71%) out of 140 patients. The lingual bone in distoangular and vertical impacted third molar was found to be 1.20 times thicker than mesioangular and horizontal teeth. Lingual bone thinning at mid-root level was observed in maximum number of cases with mesioangular teeth (68.5%), whereas horizontal impacted teeth showed lingual bone thinning (90.9%) at root apex level. The mean buccolingual angle of impacted mandibular third molar was found to be significantly associated with lingual bone perforation (p value = 0.0258). The morphology of lingual plate was observed as undercut type (37.14%) followed by slanted (36.43%), parallel (19.29%) and round type (7.14%). Increase in buccolingual angle of impacted mandibular third molar decreases lingual bone thickness which is the natural barrier for protecting injury to lingual nerve. Also undercut and slanted lingual plate shapes were recognised as risk factors for contact/perforation between root apex and lingual plate. Therefore, proper screening and planning of high risk patients before third molar extraction is crucial.

Sialendoscopy for pediatric salivary gland disorders: a study of safety and effect.

Sialendoscopy has become the preferred modality for managing pediatric salivary gland disorders (PSGD) including juvenile recurrent parotitis (JRP) and sialolithiasis. The literature remains sparse, but several case series have reported good outcomes and few complications. The aim of this study was to investigate the safety and efficacy of sialendoscopy for PSGD in a Danish setting. From a national sialendoscopy database, we included records of children who had undergone sialendoscopy for PSGD at our clinic over a 6-year period. Clinical and intraoperative data, follow-up and e-mail surveys after 1, 3 and 5 years were retrieved for analysis. We included 52 procedures on 50 glands (32 parotid, 18 submandibular) in 49 children. Of eligible patients, 90% attended clinical follow-up, 80% answered the survey after 1 year, 80% after 3 years and 60% after 5 years. JRP was diagnosed in 33 cases, obstructive causes in 18 cases. Complications noted were ductal perforation (2%), transient lingual nerve affection (4%) and infection (2%). For JRP patients, overall symptoms had improved for 96% after 3 months, 81% after 1 year and 83% after 3 years. For patients suffering from obstruction, overall symptoms were improved for 93% after 3 months and for 100% after 1 year. Sialendoscopy is a safe procedure for PSGD, and effective for sialolithiasis and symptom reduction in JRP.

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.