Neurosensory Deficit Research Articles

Coronectomy of lower third molars with and without guided bony regeneration: a pilot study

This pilot study for a split-mouth, randomised, clinical trial compared the incidence of postoperative complications, root migration, and adjacent second molar periodontal attachment after coronectomy of the lower third molars with or without guided bony regeneration. Six patients (three men and three women, mean (range) age 27 (21-44) years), each with bilateral lower third molars in close proximity to the inferior alveolar nerve, were recruited. One third molar of each patient was randomised to be treated by coronectomy with guided bony regeneration, and the other side coronectomy alone. All subjects were reviewed for 12 months. No neurosensory deficit was noted in either group. We found no significant differences between the two groups in postoperative morbidity. Mean (SD) root migration after coronectomy with guided bony regeneration at postoperative 2 weeks, 3 months, 6 months, and 12 months were 0.14 (0.34), 0.56 (0.68), 0.63 (0.83), and 0.63 (0.83) mm, respectively. These were significantly less than the results in the control group from postoperative 3 months onwards (3 months p=0.01, 6 months p=0.004, and 12 months p=0.003). There was a trend towards reduced periodontal depth at the adjacent second molar in the study group compared with that in the control group, but not significantly so. These results show that coronectomy of lower third molars with guided bony regeneration has low morbidity and seems to reduce root migration. A full-scale randomised clinical trial will show the effect on root migration and periodontal attachment of the adjacent second molar.

Post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve in mandibular fracture: a prospective study.

ObjectivesWe evaluated and recorded post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve (IAN) in mandibular fracture in order to identify associated risk factors.Materials and MethodsThis was a prospective cohort study composed of 60 patients treated for mandibular fracture. The primary study variable was the change between the post-traumatic IAN neurosensory examination score and the score after fracture reduction. Risk factors were categorized as demographic, anatomic, fracture displacement, and treatment. Appropriate descriptive and bivariate statistics were computed.ResultsSixty patients with unilateral mandibular fracture reported within 24 hours of injury were evaluated over a one-year period. A post-traumatic neurosensory deficit was observed in 52 patients (86.7%), the percentage of which was reduced to 23.3% over the follow-up period. Abnormal postoperative neurosensory scores were significantly higher in angle fracture cases (33.3%) compared to body fracture cases (11.1%). When recovered and non-recovered neurosensory scores were compared by fracture location, 88.9% of body fracture cases showed significant recovery compared to 66.7% of mandibular angle fracture cases. Cases with less than 5 mm fracture displacement showed statistically significantly higher neurosensory recovery scores (90.6%) compared to those with more than 5 mm fracture displacement (60.7%).ConclusionUse of a miniplate with mono-cortical screws does not play a role in increasing IAN post-traumatic neurosensory deficit. Early management can reduce the chances of permanent neurosensory deficit. Mandibular fracture displacement of 5 mm or more and fracture location were found to be associated with an increased risk of post-traumatic IAN neurosensory score worsening.

Management of endodontic injuries to the inferior alveolar nerve.

Functional sensory recovery from microsurgical intervention for inferior alveolar nerve (IAN) injuries resulting from endodontic treatment were evaluated using a retrospective chart review. Other variables assessed included time from injury to surgery as well as other factors which improved functional neurosensory recovery (FSR). This case series of seven patients evaluated the outcome of IAN microsurgery following endodontic-related nerve injuries. All patients were referred, evaluated, and operated on by the primary investigator (VBZ). Surgical intervention consisted of external and/or internal neurolysis with irrigation of the mandibular canal and decompression of the affected IAN as well as allogeneic nerve graft in one patient. Preoperative and postoperative sensory levels were recorded and FSR was assessed using the Medical Research Council scale. Seven subjects with a mean age of 35.57 years (range 22 to 55 years old) opted to undergo trigeminal nerve microsurgery for management of their IAN injury resulting from endodontic treatment of mandibular molar teeth. Six women and one man were included in this population. The majority of subjects presented with an initial chief complaint of dysesthesia and hypoesthesia. The mean interval between nerve injury and surgical treatment was 15 weeks (range 1 to 40 weeks). All patients had preoperative sensory level of S0, S1, or S2+, and achieved FSR following surgery. Two patients had postoperative sensory level of S3, four patients had a postoperative sensory level of S3+, and one had a postoperative sensory level of S4 (complete recovery). The results of this study suggest that trigeminal nerve microsurgery for the surgical treatment of endodontic injuries to the IAN can improve neurosensory function. Surgical intervention in this study was beneficial to alleviate neurosensory deficits and symptoms for those injuries to the IAN caused by endodontic treatment.

A functional magnetic resonance imaging study of cognitive control and neurosensory deficits in mild traumatic brain injury.

Mild traumatic brain injury patients (mTBI) frequently report symptoms of increased distractability and sensory disturbances during mutisensory stimulation. These common post-concussive symptoms could putatively result from dysfunction within the cognitive control network (CCN; top-down) or from unisensory cortex (bottom-up) itself. Functional magnetic resonance imaging (fMRI) and high-resolution structural data were therefore prospectively collected during a multisensory (audio-visual) cognitive control task from 46 mTBI patients within 3 weeks of injury and 46 matched healthy controls (HC), with a subset of participants returning at 4 months. Multisensory stimuli were presented at two frequencies to manipulate cognitive and perceptual load. Patients self-reported more cognitive, emotional, somatic, vestibular and visual symptoms relative to HC, which improved, but did not entirely resolve, over the 4 month follow-up period. There were no group differences in behavior or functional activation during cognitive control (incongruent--congruent trials). In contrast, patients exhibited abnormal activation within different regions of visual cortex that depended on whether attention was focused on auditory or visual information streams. Patients also exhibited increased activation within bilateral inferior parietal lobules during higher cognitive/perceptual loads, suggesting a compensatory mechanism to achieve similar levels of behavioral performance. Functional abnormalities within the visual cortex and inferior parietal lobules were only partially resolved at 4 months post-injury, suggesting that neural abnormalities may take longer to resolve than behavioral measures used in most clinical settings. In summary, current results indicate that abnormalities within unisensory cortex (particularly visual areas) following mTBI, which likely contribute to deficits commonly reported during multisensory stimulation.

Neuroinflammatory responses in diabetic retinopathy.

Diabetic retinopathy (DR) is a common complication of diabetes and has been recognized as a vascular dysfunction leading to blindness in working-age adults. It becomes increasingly clear that neural cells in retina play an important role in the pathogenesis of DR. Neural retina located at the back of the eye is part of the brain and a representative of the central nervous system. The neurosensory deficits seen in DR are related to inflammation and occur prior to the clinically identifiable vascular complications. The neural deficits are associated with abnormal reactions of retina glial cells and neurons in response to hyperglycemia. Improper activation of the innate immune system may also be an important contributor to the pathophysiology of DR. Therefore, DR manifests characteristics of both vasculopathy and chronic neuroinflammatory diseases. In this article, we attempt to provide an overview of the current understanding of inflammation in neural retina abnormalities in diabetes. Inhibition of neuroinflammation may represent a novel therapeutic strategy to the prevention of the progression of DR.

Comprehensive geriatric assessment: comparison of elderly hemodialysis patients and primary care patients

Backgrounds: The quality of life and survival of elderly depend not only on their age but on many social and health factors. In the present study, comprehensive geriatric assessment (CGA) was made in elderly patients on regular hemodialysis (HD) and those without chronic kidney disease recruited in primary health care in order to compare their sociodemographic characteristics, physical health, functional ability and social support. Method: The 106 HD patients and 300 primary care patients aged 70 years and more were studied. Data on sociodemographic characteristics, neurosensory deficits, pain, falls, polypharmacy, basic activities of daily living (ADL) questionnaire, instrumental activities of daily living (IADL) questionnaire were obtained during interview. The Timed Up and Go, Nutritional Health Checklist, Two Question Instrument for depression and Charlson comorbidity index (CCI) were applied. Results: No significant differences were found for age, gender, education level and dwelling between the two groups. A lower percentage of HD patients lived alone when compared with controls. BMI >25 kg/m2 had 43.4% of HD patients and 49.3% of controls. CCI differed significantly between HD and primary care patients (median: 6 vs. 4) and significantly more HD patients reported depression. No significant difference was found between groups for cognitive dysfunction and ADL, but HD patients had significantly lower IADL scores than controls. The mobility of HD patients was worse; 45.7% of them reported falls in the previous year but only 9.7% from the controls. Conclusions: CGA revealed that HD patients had significantly higher CCI, worse IADL score, mobility and reported more frequent falls, depression and impaired vision than primary care patients.

Evidence-based outcomes following inferior alveolar and lingual nerve injury and repair: a systematic review.

The inferior alveolar nerve (IAN) and lingual (LN) are susceptible to iatrogenic surgical damage. Systematically review recent clinical evidence regarding IAN/LN repair methods and to develop updated guidelines for managing injury. Recent publications on IAN/LN microsurgical repair from Medline, Embase and Cochrane Library databases were screened by title/abstract. Main texts were appraised for exclusion criteria: no treatment performed or results provided, poor/lacking procedural description, cohort <3 patients. Of 366 retrieved papers, 27 were suitable for final analysis. Treatment type for injured IANs/LNs depended on injury type, injury timing, neurosensory disturbances and intra-operative findings. Best functional nerve recovery occurred after direct apposition and suturing if nerve ending gaps were <10mm; larger gaps required nerve grafting (sural/greater auricular nerve). Timing of microneurosurgical repair after injury remains debated. Most authors recommend surgery when neurosensory deficit shows no improvement 90days post-diagnosis. Nerve transection diagnosed intra-operatively should be repaired insitu; minor nerve injury repair can be delayed. No consensus exists regarding optimal methods and timing for IAN/LN repair. We suggest a schematic guideline for treating IAN/LN injury, based on the most current evidence. We acknowledge that additional RCTs are required to provide definitive confirmation of optimal treatment approaches.

Efficacy and Versatility of the 3-D Titanium Mesh Implant in the Closure of Large Post-Craniectomy Osseous Defects, and its Therapeutic Role in Reversing the Syndrome of the Trephined: Clinical Study of a Case Series and Review of Literature.

An ideal cranioplasty material is one which adequately restores calvarial continuity, contour and esthetics, provides adequate cerebral protection, is biocompatible and corrosion resistant, lightweight yet strong, easy to manipulate and possesses long term stability. The 3-D Titanium mesh implant fulfills most of these criteria, and offers certain added advantages, as exemplified in this case series. Four patients with post craniectomy osseous defects of varying sizes and at different locations of the calvarium were studied. In addition to the obvious cosmetic deformity, the patients also exhibited various subjective and objective features of neurosensory and motor deficits characteristic of the motor trephine syndrome (MTS), that often develops secondary to large cranial defects. There have been no documented reports so far on the effect of Titanium mesh cranioplasty on features of the MTS in patients with large cranial defects. It was the objective of this study to see if any specific therapeutic goals such as reversal of the neurological deterioration and sensorimotor deficits associated with the syndrome could be achieved by performing Titanium mesh cranioplasty to reconstruct the missing part of the cranial shield in these patients. Any added benefits of using 3-D Titanium mesh as a cranioplasty material were also recorded. The cranial defects in all four patients were reconstructed using different dimensions of Titanium mesh implants. Two of the cases were early cranioplasties (performed within 3months of craniectomy) and two were late cranioplasties (performed after 3months of craniectomy), one of them even being a previous autologous bone flap cranioplasty failure. The patients were followed up for a period ranging from 3 to 4years and observed carefully for cosmetic, functional and neurological improvements following the cranioplasty. There was achieved gratifying cosmetic correction of the cranial deformities, and remarkable functional recovery from the sensorimotor deficits, reversal of the neurological deterioration as well as resolution of most of the symptoms of MTS in all the four patients, following the Titanium mesh cranioplasty. Many added benefits were noted, such as quick post operative recovery, absence of any early or late complications and a ready means to aspirate any epidural collections, if they developed post operatively, through the mesh structure of the implant. Apart from the cosmetic, functional and protective roles, Titanium mesh cranioplasty demonstrated a definite therapeutic role in all the cases presented, making it preferable to even replacement with natural bone (either re-implanted excised autologous bone flaps, or cortico-cancellous bone autografts). It is an extremely safe and reliable alternative to autografts, and is even preferable to them, especially when the size of the cranial defect is large.

Trials needed to identify best management of iatrogenic inferior alveolar and lingual nerve injuries.

The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched with no language or date restrictions. Three reviewers independently selected studies. Randomised controlled trials (RCTs) involving interventions to treat patients with neurosensory defect of the inferior alveolar or lingual nerve or both as a sequela of iatrogenic injury were considered. Standard Cochrane methodological procedures were followed. Two studies considered at high risk of bias, reporting data from 26 analysed patients were included. Both studies investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury. Two studies assessed as at high risk of bias, reporting data from 26 analysed participants were included in this review. The age range of participants was from 17 to 55 years. Both trials investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury.Patient-reported altered sensation was partially reported in one study and fully reported in another. Following treatment with laser therapy, there was some evidence of an improvement in the subjective assessment of neurosensory deficit in the lip and chin areas compared to placebo, though the estimates were imprecise: a difference in mean change in neurosensory deficit of the chin of 8.40 cm (95% confidence interval (CI) 3.67 to 13.13) and a difference in mean change in neurosensory deficit of the lip of 21.79 cm (95% CI 5.29 to 38.29). The overall quality of the evidence for this outcome was very low. No studies reported on the effects of the intervention on the remaining primary outcomes of pain, difficulty eating, speaking or taste. No studies reported on quality of life or adverse events. There is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychological interventions for iatrogenic inferior alveolar and lingual nerve injuries. Primary outcomes of this research should include: patient-focused morbidity measures including altered sensation and pain, pain, quantitative sensory testing and the effects of delayed treatment.

Stellate Ganglion Block, Compared With Xenon Light Irradiation, Is a More Effective Treatment of Neurosensory Deficits Resulting From Orthognathic Surgery, as Measured by Current Perception Threshold

The aim of this study was to evaluate the relative effectiveness of stellate ganglion blockade (SGB) versus xenon light irradiation (XLI) for the treatment of neurosensory deficits resulting from orthognathic surgery as determined by a comparison of prospective measurements of electrical current perception thresholds (CPTs) and ranged CPTs (R-CPTs). CPT and R-CPT in the mental foramen area were measured during electrical stimulation at 98 different sites on the body in patients who had undergone orthognathic surgery. After surgery, patients were assigned to the SGB group or the XLI group. CPT and R-CPT of the 2 groups were measured at stimulation frequencies of 2,000, 250, and 5 Hz before surgery, 1 week after surgery, and after 10 treatment sessions. Furthermore, the influence of surgical factors, such as genioplasty and a surgically exposed inferior alveolar nerve (IAN), was examined in the 2 groups. Patients' CPT and R-CPT values indicated a considerable amount of sensory disturbance in most cases after surgery. The change in magnitude of all CPT and R-CPT values for the SGB group decreased considerably compared with that for the XLI group after treatment. There was no correlation between CPT or R-CPT values and surgical factors (eg, genioplasty and exposure of the IAN). SGB of the IAN could be an effective method for treating neurosensory deficits after orthognathic surgery on the IAN.

The epidemiology, treatment, and complication of dentofacial deformities in an Indonesian population: A 21-year analysis

ObjectiveThe aim of the present study was to investigate the prevalence, treatment, and complication of patients with dentofacial deformities in an Indonesian cohort. Materials and methodsStudy cohorts included 86 patients who were treated for dentofacial deformities with orthognathic surgery from January 1990 to December 2011. The inclusion criteria were the presence of a nonsyndromic dentofacial deformity and the exclusion criteria were facial asymmetry and cleft lip and palate. Data from each patient, including gender, age, deformity classification, surgical procedure, location of surgical procedure, and complication were reviewed and analyzed retrospectively. ResultsMandibular prognathism with an open bite was the most prevalent deformity (46.5%). Mandibular deficiency was the least prevalent deformity (2.3%). The bimaxillary surgical procedure was most frequently conducted (72.1%), bimaxillary osteotomies were performed in 95% of patients with mandibular prognathism with open bite (P<0.00). The most common surgical procedure to treat mandibular prognathism with an open bite was the Le Fort I osteotomy (35.8%), followed by genioplasty (28.7%), intraoral vertical ramus osteotomy (24.1%), and sagittal split osteotomy (12%) (P<0.00), and few complications were reported following surgery, including infection, plate exposure, mile edge-to-edge relapse, and neurosensory deficit of the inferior alveolar nerve (P<0.00). ConclusionThe most common deformity was mandibular prognathism with open bite, and the majority of these cases required bimaxillary osteotomies. A small number of patients exhibited complications. These present results may reflect the dentofacial deformities that are observed in Southeast Asian patients.

Coronectomy (Intentional Partial Odontectomy) in Lower Third Molar as an Alternative Treatment: Report of Two Cases

The principle of coronectomy or intentional partial odontectomy is the removal of the tooth crown, leaving the root in situ. This technique aims to prevent damage to inferior alveolar nerve while applying to removal a third molar or posterior tooth impacted in mandible. In this study, we report two clinical cases with the impacted lower third molar presented roots in close proximity to the mandibular canal and by intentional partial odontectomy. Neurosensory deficits, postoperative infection, periods off follow up and surgical outcomes were emphasized in this study. We concluded that the intentional partial odontectomy is a foreseeable technique and easy to perform in an outpatient setting. It is an alternative procedure in the extraction of impacted lower third molar that has a close relationship with mandibular canal.

Use of Three-dimensional Plates in Mid-face Fracture: A Prospective Study

The aim of our study was to evaluate the advantages and disadvantages of three-dimensional (3D) plating system in the treatment of mid-face fractures. Thirty mid-face fractures in 18 patients at various anatomic locations were treated by open reduction and internal fixation using 3D plates. All patients were followed at regular intervals of 4th, 8th and 12th weeks respectively. Patients were assessed postoperatively for postoperative complication and occlusal stability. The incidence of neurosensory deficit, infection, masticatory difficulty, nonunion and malunion was also assessed. A significant reduction in fracture (72.2%) and occlusal stability (72.2%) was seen. The overall complication rate was (16.6%) which included two patients who developed postoperative paresthesia of lip, three patients had infection and two cases of masticatory difficulty which later subsided by higher antibiotics and 4 weeks of MMF. No evidence of nonunion and malunion was noted. Single 3D titanium plates with 1.7 mm diameter holes and 1.7 mm screws were reliable and an effective treatment modality for mid-face fracture. Because of unique biogeometrical design owing to lesser amount of hardware material (fixation device) resulting into increased stability, the fixation in mid-face fractures is better in comparison to conventional 1.5 mm miniplate fixation.

The Effect of Trigeminal Neurosensory Deficit on Quality of Life

The Effect of Trigeminal Neurosensory Deficit on Quality of Life

Lower extremity neuromuscular compensations during instrumented single leg hop testing 2-10 years following ACL reconstruction.

This study compared lower extremity EMG activation and sagittal plane kinematics of subjects at a minimum of 2 years post-successful ACL reconstruction and rehabilitation during instrumented single leg hop testing. Comparisons were made based on subject responses to the following question, "compared to prior to your knee injury how capable are you now in performing sports activities"? Group 1=very capable, Group 2=capable, and Group 3=not capable. In addition to EMG (1000 Hz) and kinematic (60 Hz) data, subjective knee function, internal health locus of control, sports activity characteristics (intensity, frequency) pre-knee injury, and at follow-up were also compared. Group 3 had lower perceived knee function, decreased perceived sports intensity, and more subjects with decreased sports activity intensity by two levels compared to pre-injury values. Perceived function scores, anterior laxity measurements and grades were similar between groups. During single leg hop propulsion and landing Group 1 (very capable) had greater involved lower extremity gluteus maximus and medial hamstring activation amplitudes than Group 3 (not capable). Perceived sports capability was related to better subjective knee function, and higher perceived sports activity intensity. Neuromuscular compensations suggesting a hip bias with increased gluteus maximus and medial hamstring activation were identified at the involved lower extremity among most subjects who perceived high perceived sports capability compared to pre-injury status. These compensations may be related to a permanent neurosensory deficit, and its influence on afferent pathway changes that influence CNS sensorimotor re-organization.

Association of frailty markers with treatment decision in patients seen in oncogeriatric clinic: Results from the ASRO pilot study.

9552 Background: Comprehensive geriatric assessment (CGA) is the gold standard to help oncologist in choosing the best cancer treatment in their older patients. Some authors recently suggest that the concept of frailty, developed by L Fried, could be a more useful approach in this population. We investigated if frailty markers (FM) are associated with treatment recommendations in an oncogeriatric clinic. Methods: This prospective multicenter study included patients 65 years and older, with solid tumors, referred to the oncogeriatric consultation after a cancer treatment plan. A CGA includes 9 domains (autonomy, comorbidities, medication, cognition, nutrition, mood, neurosensory deficits, falls and social status) was performed. Five FM were assessed (nutrition, physical activity, energy, mobility, strength). Patients were classified as Frail (3 or more FM), pre frail (1 or 2 FM) or not frail (0 FM). Treatment recommendations were classified in 3 categories: Standard treatment, Standard treatment with adapt...

Interventions for iatrogenic inferior alveolar and lingual nerve injury.

Iatrogenic injury of the inferior alveolar or lingual nerve or both is a known complication of oral and maxillofacial surgery procedures. Injury to these two branches of the mandibular division of the trigeminal nerve may result in altered sensation associated with the ipsilateral lower lip or tongue or both and may include anaesthesia, paraesthesia, dysaesthesia, hyperalgesia, allodynia, hypoaesthesia and hyperaesthesia. Injury to the lingual nerve may also affect taste perception on the affected side of the tongue. The vast majority (approximately 90%) of these injuries are temporary in nature and resolve within eight weeks. However, if the injury persists beyond six months it is deemed to be permanent. Surgical, medical and psychological techniques have been used as a treatment for such injuries, though at present there is no consensus on the preferred intervention, or the timing of the intervention. To evaluate the effects of different interventions and timings of interventions to treat iatrogenic injury of the inferior alveolar or lingual nerves. We searched the following electronic databases: the Cochrane Oral Health Group's Trial Register (to 9 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 9 October 2013) and EMBASE via OVID (1980 to 9 October 2013). No language restrictions were placed on the language or date of publication when searching the electronic databases. Randomised controlled trials (RCTs) involving interventions to treat patients with neurosensory defect of the inferior alveolar or lingual nerve or both as a sequela of iatrogenic injury. We used the standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of the risk of bias independently and in duplicate. We contacted authors to clarify the inclusion criteria of the studies. Two studies assessed as at high risk of bias, reporting data from 26 analysed participants were included in this review. The age range of participants was from 17 to 55 years. Both trials investigated the effectiveness of low-level laser treatment compared to placebo laser therapy on inferior alveolar sensory deficit as a result of iatrogenic injury.Patient-reported altered sensation was partially reported in one study and fully reported in another. Following treatment with laser therapy, there was some evidence of an improvement in the subjective assessment of neurosensory deficit in the lip and chin areas compared to placebo, though the estimates were imprecise: a difference in mean change in neurosensory deficit of the chin of 8.40 cm (95% confidence interval (CI) 3.67 to 13.13) and a difference in mean change in neurosensory deficit of the lip of 21.79 cm (95% CI 5.29 to 38.29). The overall quality of the evidence for this outcome was very low; the outcome data were fully reported in one small study of 13 patients, with differential drop-out in the control group, and patients suffered only partial loss of sensation. No studies reported on the effects of the intervention on the remaining primary outcomes of pain, difficulty eating or speaking or taste. No studies reported on quality of life or adverse events.The overall quality of the evidence was very low as a result of limitations in the conduct and reporting of the studies, indirectness of the evidence and the imprecision of the results. There is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychological interventions for iatrogenic inferior alveolar and lingual nerve injuries. Primary outcomes of this research should include: patient-focused morbidity measures including altered sensation and pain, pain, quantitative sensory testing and the effects of delayed treatment.

Evaluation of Neurosensory Deficits in Maxillofacial Surgery

ABSTRACT It is a prospective study to evaluate the neurosensory deficits in patients that came to MGM Dental College and Hospital, Navi Mumbai from January 2010 to November 2011. One hundred seventy-seven patients were evaluated and they were divided into three subgroups: trauma, surgical extractions and pathology. The study was conducted to evaluate the sexwise, agewise, the description of the neurosensory deficit, the most susceptible area of neurosensory deficit as well as the agewise and sexwise recovery pattern of the neurosensory deficit. The statistical analysis showed that the neurosensory deficits were more common than females, the age group in which the deficits were more common was in between 25 and 50 years. The area most commonly affected was the chin and lower lip. The recovery patterns also showed that males and the age group of 25 to 50 years showed faster recovery. How to cite this article Poonja KS, Galinde JS. Evaluation of Neurosensory Deficits in Maxillofacial Surgery. J Contemp Dent 2014;4(2):72-76.

Labial sensory impairment following extraction of impacted mandibular third molars

Introduction: The purpose of this study was a prospective investigation into the occurrence of impairment of labial sensation after surgical removal of impacted third molars. Aims and Objectives: The aim of this study was to determine the incidence of postoperative sensory impairment of inferior alveolar nerve (IAN) after extraction of impacted mandibular third molars. Materials and Methods: The study sample consisted of 200 patients who were indicated for removal of impacted mandibular third molars. Extraction of the impacted tooth was done by using surgical bur technique. Postoperatively, patients were evaluated for impairment of labial sensation. Objective evaluation of IAN was carried out using light touch sensation, tactile discrimination, pain awareness, and two point discrimination. Results: Of 200 subjects, only two patients showed neurosensory deficit in relation to IAN. Conclusion: The main cause of neurosensory impairment was due to variables associated with tooth position, degree of impaction, operator skill and also depth of impaction and age of the patient.

Clinical significance of computed tomography assessment for third molar surgery.

Surgical extraction of the third molar is the most commonly performed surgical procedure in the clinical practice of oral surgery. Third molar surgery is warranted when there is inadequate space for eruption, malpositioning, or risk for cyst or odontogenic tumor formation. Preoperative assessment should include a detailed morphologic analysis of the third molar and its relationship to adjacent structures and surrounding tissues. Due to developments in medical engineering technology, computed tomography (CT) now plays a critical role in providing the clear images required for adequate assessment prior to third molar surgery. Removal of the maxillary third molar is associated with a risk for maxillary sinus perforation, whereas removal of the mandibular third molar can put patients at risk for a neurosensory deficit from damage to the lingual nerve or inferior alveolar nerve. Multiple factors, including demographic, anatomic, and treatment-related factors, influence the incidence of nerve injury during or following removal of the third molar. CT assessment of the third molar prior to surgery can identify some of these risk factors, such as the absence of cortication between the mandibular third molar and the inferior alveolar canal, prior to surgery to reduce the risk for nerve damage. This topic highlight presents an overview of the clinical significance of CT assessment in third molar surgery.