Neurosensory Disturbance Research Articles

Effect of transcutaneous electrical nerve stimulation on neuro-sensory disturbance after orthognathic surgery: a randomized clinical trial.

The present study aims to determine the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on neuro-sensory disturbance after orthognathic surgery. In a randomized clinical trial, the participants via split-mouth sampling were randomly divided into two intervention (n=27) and control (n=27) groups. In the intervention group, participants received TENS physiotherapy. TENS physiotherapy was performed on the day after surgery, 1, 2, 3, and 4 weeks after surgery, along with prescriptions for the use of painkillers. On the control group, no physical therapy was performed and the patients only used painkillers (immediately after the operation). Paresthesia was evaluated using the 2-point discrimination (TPD) test and the semi-quantitative sensory-neural disorders test called brush stroke 6 months after the surgical procedures. Self-reported sensory-neural disorders were measured and reported for each patient before and 6 months after surgery using the visual analog scale (VAS). A total of 54 patients participated in this study. The mean TPD score in the TENS group and the control group 6 months after the operation were 5.76 (SD=0.73) and 6.14 (SD=0.54), respectively (P=0.003). The mean VAS score in the TENS group and the control group 6 months after the operation was 6.48 (SD=0.50) and 5.80 (SD=0.63), respectively (P=0.005). Also, 66.7 and 38.9% in the TENS and control groups, respectively, performed the brush stroke test correctly (P=0.007). In sum, the benefits of TENS physiotherapy can be effective in reducing complications such as pain in dental surgery treatments or orthognathic surgeries.

Factors predicting neurosensory disturbance after bilateral sagittal split ramus osteotomy: a retrospective cohort study

Neurosensory disturbances (NSD) are the most widely recognized complication of bilateral sagittal split ramus osteotomy (BSSRO), but predictors of NSD remain unclear. The aim of this study was to identify factors predicting NSD following BSSRO. A retrospective cohort study of 129 consecutive patients with dentofacial deformities (median age 24.0 years; 76.0% female), who underwent BSSRO (95 without genioplasty, 34 with genioplasty), was conducted. The presence of NSD was evaluated at 6 months postoperatively and was found in 97 patients (absent in 32 patients). Potential NSD-related factors investigated were age, sex, genioplasty, mandibular canal type, inferior alveolar nerve (IAN) exposure, mandibular movement, and laterality. Multivariate binary logistic regression analysis was conducted to elucidate factors predicting NSD, with calculation of odds ratios (OR) and 95% confidence intervals (CI). The dependent variable was defined as NSD after BSSRO. Independent variables were those with P < 0.100 in the univariate analysis. In the multivariate binary logistic regression analysis, NSD showed a significant association with BSSRO with genioplasty (adjusted OR 3.87, 95% CI 1.21–12.26; P = 0.022) and left IAN exposure (adjusted OR 4.69, 95% CI 1.49–14.73; P = 0.008). The study findings may lead to enhanced clinical outcomes for BSSRO.

Are There Differences in the Causes and Complications of Mandibular Third Molar Extraction in Older Patients Compared to Younger Patients?

BackgroundAlthough most impacted third molars (ITM) are extracted in the teens and early 20s, some undergo extractions after their 40s. It is unclear whether the reasons for extraction, the degree of impaction, and complications differ in patients in an older age group compared with a younger age group. PurposeThe purpose of this study was to measure the association between age and 1) reason for extraction and 2) postoperative complications. Study design, setting, sampleThis was a retrospective cohort study of patients who had undergone surgical extraction of at least one mandibular ITM at a single institution. We excluded 1) age under 20 years, 2) follow-up period of less than 1 week, and 3) tooth extraction under general anesthesia. Predictor variableThe primary predictor variable was age, classified into 3 groups (20s:20-29; 30s:30-39; over 40s: 40 and greater). Outcome variableThe primary outcome variables were reason for extraction (prophylactic or symptomatic) and presence of complications. The secondary outcome variable was type of complication (post-operative infection, dry socket, neurosensory disturbance, presenting pain over 1 month, retained root requiring secondary treatment). CovariatesThe covariates were sex, laterality of ITM, and difficulty of extraction as measured by the difficulty index, a measure based on depth, orientation, and ramus relationship/space available, with a higher score indicating greater difficulty. AnalysesChi-square test was performed to analyze the association of categorical outcome variables and covariates. Level of statistical significance was set at P<0.05. ResultsOf a total of 831 eligible subjects, there were 555 (66.8%), 159 (19.1%), and 117 (14.1%) in 20s, 30s and over 40s age groups, respectively. The percentage of symptomatic extraction of ITM was significantly higher in the over 40 age group compared with the 20s group (92.3% vs. 69.4%, (p<0.001). Complication rate also significantly differed between over 40s group and the 20s group (7.7% vs. 1.8%, p<0.001). Difficulty index and indications for ITM extraction were significantly different between groups (p<0.001). ConclusionSymptoms, difficulty, and complications related to ITM increase at over 40 years of age. This should be taken into consideration during the joint clinical decision-making process with patients with ITM.

Efficacy of photobiomodulation following L-PRF application for recovery of mental nerve neurosensory disturbances caused by genioplasty: A randomized triple-blind clinical trial

The present study assessed the efficacy of photobiomodulation (PBM) following leukocyte-platelet rich fibrin (L-PRF) application for recovery of mental nerve neurosensory disturbances (NSDs) caused by genioplasty. This randomized triple-blind split-mouth clinical trial was conducted on 20 female patients (40 quadrants) requiring genioplasty. In each patient, one random side of the mandible served as the intervention (laser), and the other side as the control group. After genioplasty and L-PRF application, the intervention side underwent GaAIAs diode laser irradiation (880 nm, 500 mW, 15 J/cm2, 0.5 cm2 spot size, continuous-wave). Each point was laser irradiated for 15 s. Unilateral extraoral PBM was performed at 1, 3, 7, 14, 21, and 28 days, postoperatively. Laser in off mode (sham laser) was used for the control side. A visual analog scale (VAS) was used for general sensitivity, and 2-point discrimination, directional discrimination, pain discrimination, and thermal discrimination tests were used to assess the neurosensory recovery at 2 days, 2 weeks, 4 weeks, and 2 months, postoperatively. Statistical analyses were performed using two-way repeated measures ANOVA, Bonferroni test, and generalized estimating equation (alpha = 0.05). Time had a significant effect on improvement of all sensory variables (P < 0.05). Neurosensory recovery was significantly better in the intervention than the control group at all time points according to the two-point discrimination test (P = 0.0135) and brush test (P = 0.025) results. The interaction effect of time and intervention was not significant on any dependent variable (P > 0.05). Application of L-PRF + PBM resulted in significantly greater sensorineural recovery according to the two-point discrimination and brush test results.

Occurrence of neurosensory disturbance after the use of articaine and lidocaine in the inferior alveolar nerve block: a double-blind randomised clinical trial

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study’s predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18–44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.

Outcomes and complications of orthognathic surgery in older patients

PurposeSeveral studies have described the outcomes and complications following orthognathic surgery. However, the average patient age in these studies is 20–40 years. It is unclear whether results from these age groups can be extrapolated to older patients. MethodsThis retrospective observational study included 54 patients over 50 years of age, who underwent orthognathic surgery. From these patients’ medical records, we retrieved data regarding patient characteristics, surgery characteristics, outcomes, and complications. ResultsThe patients’ mean age was 56 years (range, 50–69 years), and mean ASA score was 2. A bad split occurred in one patient, and immediate postoperative complications occurred in two patients. There were no long-term sequelae. Neurosensory disturbances (NSD) occurred in 30 patients. Preoperative temporomandibular dysfunction (TMD) was present in 9 patients—among whom, five were cured after surgery. Four patients postoperatively developed de novo TMD. Hardware removal was performed in 22 patients. The mean length of stay was two days for monomaxillary procedures, and three days for bimaxillary procedures. ConclusionsThis study demonstrated apparent differences between patients over 50 years of age and the general orthognathic population. In particular, neurosensory disturbances and hardware removal were more prevalent in our study population.

The Effect of Delayed Photobiomodulation Therapy on Inferior Alveolar Nerve Recovery After Third Molar Removal: A Triple-Blinded Randomized Clinical Trial.

Background: Third molar removal is the primary reason for inferior alveolar nerve (IAN) damage, with 2% causing persistent neurosensory deficits. This study aimed to investigate how delayed photobiomodulation therapy affects long-lasting neurosensory disturbances. Methods: This study was conducted on patients with neurosensory disturbances lasting longer than 6 months. Patients were randomly allocated to the study and control groups, with the study group receiving a low-power diode laser (continuous wavelength of 810 nm, power of 200 mW) on 16 points (30 sec at each) for 12 sessions (2 sessions/week), while the control group received a placebo treatment by switched-off laser probe. Visual analog scale (VAS; ranging from 1 to 5), static light touch, two-point discrimination, direction discrimination, pinprick, and thermal discrimination tests were performed on each visit up to 9 months post-therapy to evaluate the recovery status. Results: Each group comprised 18 participants. The mean time since injury was 8.26 ± 2.05 and 8.38 ± 1.98 months for the control and intervention groups, respectively (p = 0.81). There was a significant improvement in the intervention group on the static light touch (p = 0.041), two-point discrimination (p = 0.028), VAS (p = 0.031), and pinprick (p = 0.014) tests on the 11th session and subsequent visits and also on direction discrimination test on the 12th session (p = 0.044) and after that. There was no significant difference in the thermal discrimination tests between the two groups (p > 0.05). Conclusion: Photobiomodulation demonstrated potential benefits in resolving persistent neurosensory deficits of the IAN, with noticeable improvements typically observed after around 35 days of treatment initiation (10 sessions).

Does Platelet-Rich Fibrin Enhance Recovery From Neurosensory Disturbance Following Mandibular Fractures? A Double-Blind, Split-Mouth Randomized Clinical Trial

Study Design Randomized Clinical Trial. Objective Mandibular body fractures may result in inferior alveolar nerve damage. This study examined the effectiveness of platelet-rich fibrin (PRF) application to the inferior alveolar nerve during open reduction and internal fixation (ORIF) of mandibular fractures. Methods This was a double-blind, split-mouth randomized clinical trial. Patients with bilateral mandibular body fractures with minimal displacement (&lt;5 mm) who underwent ORIF were assessed for enrollment. PRF was placed within the fracture site before reduction and fixation on the studied side. Fixation was performed on the contralateral side (control side) without PRF. The study and control groups were randomized using QuickCalcs software. Neurosensory disturbance (NSD) was assessed through two-point discrimination (TPD), self-reported NSD (SR-NSD), and brush directional stroke discrimination test (BDSD) at 6 and 12 months postoperatively. Results Twenty-five subjects were enrolled. BDSB recovery was greater in the study group during all time intervals ( P &lt; .001). There were no differences between TPD and SR-NSD at the follow-up periods ( P &gt; .05). Conclusions The results of this split-mouth randomized clinical trial indicate that PRF may enhance the recovery of a damaged inferior alveolar nerve in mandibular body fractures.

Risk Factors Associated With Inferior Alveolar Nerve Injury After Extraction of Impacted Lower Mandibular Third Molars: A Prospective Cohort Study

BackgroundInferior alveolar nerve (IAN) injury is one of the complications of impacted lower mandibular third molar (LM3) extraction. Given the unknown prognosis of IAN injuries and limited treatment options, it is critical to understand the risk factors of IAN injury before LM3 extraction. PurposeThe study purpose was to identify risk factors associated with IAN injury after LM3 extraction. Study design, setting, sampleThis was a prospective cohort study including patients who underwent LM3 extraction from May to December in 2021 at authors’ institution. Patients with systemic diseases, previous maxillofacial surgeries or sensory abnormalities were excluded. Predictor variable(s)The predictor variable is composed of several risk factors. The variables were grouped into four categories: demographic, radiographic, procedure-related, and surgeon experience. Main outcome variable(s)The outcome variable was postoperative neurosensory disturbance coded as present or absent and was measured as one-month (transient) and one-year (permanent). CovariatesNot applicable. AnalysesThe measurement data were represented by mean and standard deviation (SD). The association of each variable with the presence of IAN injury was tested by the chi-square test. Statistical significance was accepted at p < 0.05. ResultsThe study sample was consisted of 705 patients (37.0% male) with an average age of 28.51 ± 6.51 years. A total of 17/705 (2.4%) and 4/705 (0.57%) patients developed transient and permanent IAN injury. The results demonstrated that the following factors were associated with higher rates of transient injury: use of chisels during surgeries (6.4%; 95% CI: 2.7-12.3; p=0.02; RR=11.4), LM3s located below the IAN canal (8.7%; 95% CI: 4.3-15.7; p<0.01; RR=7.3), compressed contact between LM3s and the IAN canal (36.4%; 95% CI: 12.3-78.2; p<0.001; RR=25.4), and not using corticosteroids after surgeries (3.8%; 95% CI: 1.9-6.5; p=0.03; RR=3.1). The only factor associated with permanent injury was compressed contact between LM3s and the IAN canal (18.2%; 95% CI: 2.2-62.3; p<0.001; RR=48.2). Conclusions and RelevanceClose proximity between LM3s and IAN canal, and the use of chisels, increase the risk of transient IAN injury. Corticosteroid treatment may promote nerve recovery. Compressed contact between LM3s and IAN canal is the only risk factor for permanent injury.

After 4 years of survival, patients treated for an oral or oropharyngeal cancer have more neurosensorial disorders than chronic pain and a better quality of life

PurposeDuring follow-up, patients in remission after oral or oropharyngeal cancer are few to express pain, depression or anxiety, their chief complain are dry mouth and difficulties to chewing. The aim of the study is to estimate prevalence of pain, quality of life and their evolution over four years. MethodsThis prospective observational study included 21 patients between June and September 2017. Clinical examination, neurosensory examination and questionnaires (using visual analogic scale DN4, PCS-CF, HADS EORTC QLQ30 and H&N 35) were performed and a second time 4 years later. ResultsAfter 4 years, 17 patients could be reviewed. In 2017 as in 2021, two patients (11.8 %) experience neuropathic pain. In 2017, 14 (82.3 %) reported paresthesia or dysesthesia or hypo/anesthesia, none of them have provoked pain to a mechanical or thermal stimulus. In 2021, only 9 (53 %) still report those symptoms. Global analysis of the questionnaire QLQC30 reveals a significant increase quality of life of all 17 patients (p = 0.0003). For the two questionnaires QLQC30 and QLQ-H&N 35, dry mouth, sticky saliva, difficulties for eating and relation with food, are strong grievances which an absence of amelioration or a degradation. ConclusionsNeurosensory disturbance is a frequent symptom but pain concerns only 11.8 % of patients. Quality of life increase globally, yet difficulties concerning oral cavity functions endure. Implications for Cancer SurvivorsFor remission patients, pain is an unfrequent situation unlike neurosensory disturbance. Support care improve life quality. In case of onset of pain, recurrence and osteoradionecrosis should be mentioned immediately.

Evaluation of Intraoperative Inferior Alveolar Nerve Exposure During and Postoperative Neurosensory Disturbances after Bilateral Sagittal Split Osteotomy: A Prospective Cross-sectional Study in Iran

Introduction: Inferior Alveolar Nerve (IAN) exposure and neurosensory disturbances (NSDs) following bilateral sagittal split osteotomy (BSSO) of the mandible are paramount. We aimed to assess intraoperative IAN exposure during and NSDs after BSOO surgery using different clinical assessment methods in a prospective study in a local setting.&#x0D; Materials and methods: The present study was a prospective cross-sectional study. We monitored the nerve exposure status during the BSSO. Our time points were: before surgery, one day after, one month later, three months after and six months after the BSSO surgery. We performed two-point discrimination test, static light touch test and pinprick test on both mental regions of the cases.&#x0D; Results: We included seven women and eight men. The average age of the participants was 25.13 ± 3.27 years. The results of the two-point discrimination test showed the following: the day after the BSSO compared to before the surgery, the sensation is significantly impaired in both mental regions. In addition, it is noted that during our study, the two-point discrimination test results showed a gradient healing, though not reaching the point before the surgery (P&gt;0.05). The results of the Pinprick test also showed a gradual resolution of the NSDs; however, a significant sensation difference remained between six months after the BSSO and before the surgery.&#x0D; Conclusion: The BSSO surgery significantly impairs the IAN sensation, causing intraoperative IAN exposure and postoperative NSDs for the patients. A gradient resolution of the NSDs was observed in all the cases, though; the sensation of the mental region did not reach the pre-surgical levels.

Effects of melatonin on postoperative pain and sensory recovery following zygomaticomaxillary complex fractures — A randomized controlled trial

Posttraumatic and postsurgical sensory disturbance is a known complication of almost all zygomaticomaxillary (ZMC) complex fractures involving the infraorbital nerve, for which few treatments are effective. Our study used neurosensory assessments to evaluate the efficacy of melatonin on pain and nerve healing following ZMC surgery.Sixty-four randomly allocated ZMC fracture patients were prophylactically administered either oral melatonin or an identical placebo for 15 consecutive days. Pre- and postsurgical clinical parameters included subjective pain, numbness, and objective neurosensory function.Melatonin significantly reduced subjective pain perception in the early postoperative days, with a significant difference in VAS scores between the groups from postoperative day 3 (p = 0.048) until day 7 (p = 0.002). The VAS assessment of subjective numbness perception showed significantly lower self-perceived neurosensory disturbance for patients in the interventional group from the first month (p = 0.039) until the third month (p = 0.005). Objective neurosensory assessment using the pinprick test and two-point discrimination showed statistically significant improvement to almost normal sensation by the first month (p = 0.014) to fully normal sensation by the third month (p = 0.001).The study findings suggest that the prophylactic administration of melatonin confers significant clinical benefits in terms of reduced postoperative pain and improved sensory recovery.

Effect of betamethasone injection into the pterygomandibular space on the neurosensory disturbance after bilateral sagittal split ramus osteotomy: a pilot study

AimThe aim of this study was to evaluate the effect of local betamethasone injection into the pterygomandibular space on postoperative neurosensory deficits.Materials and methodsA prospective controlled clinical study was conducted on 16 patients (6 male, 10 female; mean age, 24.95 ± 9.22 years) who underwent bilateral sagittal ramus osteotomy for mandibular discrepancies. One side of each patient’s mandible was randomly selected as the control side, and the opposite side as the experimental side. On the experimental side, a solution of betamethasone (6 mg/1 ml) was injected into the pterygomandibular space after the completion of wound closure. Neurosensory tests, including light touch, two-point discrimination, direction of movement, thermal sensitivity, and pin-prick discrimination, were performed. The follow-up period ranged between 6 and 12 months, according to the particular sensory test. The Fisher exact test was used to analyse the data.ResultsThe light touch sensation was abnormal in 75% of the control side and 31% of the study side, with the difference being significant (p = 0.03). However, at 6 months, all the study cases regained touch sensation, compared to 69% of the control side. No significant difference in direction movement discrimination was seen; however, at 3 months, the study side showed significantly less direction sensation (19%) compared to the control side (56%) (p = 0.02). There was no significant difference in the two-point discrimination; however, at 3 months, the study side had a significantly less abnormal two-point sensation (13%) than the control side (56%) (p = 0.02). In addition, no significant difference was noted in thermal sensitivity or pin-prick sensation.ConclusionBetamethasone injection into the pterygomandibular space reduces neurosensory disturbances after bilateral sagittal split ramus osteotomies nd leads to faster recovery of sensations.

Parallel osteotome technique: new approach to reduce neurosensory disturbances following bilateral sagittal split osteotomy.

To determine clinically if parallel osteotome technique (POST) reduces incidence of neurosensory disturbances (NSD) following bilateral sagittal split osteotomy (BSSO), and to corroborate the findings with finite element analysis (FEA). The investigation was a quasi-experimental study involving 30 patients requiring BSSO. The sample was divided into two groups: control undergoing conventional osteotomy technique and experimental using POST. An FEA simulation of the two advocated techniques were also generated for computational analysis. Primary outcome was clinical comparison of subjective and objective measures for NSD, while secondary outcome was comparison of stress, strain and deformation. Osteotomy technique was the exposure studied. Data was analyzed for differences in proportions and means. Thirty patients (12 females and 18 males) with an age range of 18 to 28 (mean 21.6) years were recruited for the study. This provided 60 sides as sample for the study. The experimental group demonstrated significantly lower subjective scores for NSD for the 3 rd (p=0.03) and 6 th month reviews (p=0.025). Objective testing revealed lower incidence of NSD for the experimental group during the 3 rd (p=0.07), 6 th (p=0.007) and 12 th post-operative months (p=0.17). The computational analysis also revealed significantly lower stress (p=0.007), strain (p=0.009) and deformation (p=0.04) on the inferior alveolar nerve with the POST method. Incidence of NSD following BSSO is lower with POST. The technique also induces significantly lower deformational forces on the IAN when compared with the conventional osteotomy method.

Neurosensory Recovery Following Skeletonization of Mental Nerve During Open Reduction &amp; Internal Fixation for Mandibular Fractures

Background: Intraoral open reduction and internal fixation (ORIF) procedures used to treat mandibular fractures can result in neurosensory abnormalities due to soft tissue and nerve manipulation. While treating fractures located in the parasymphysis and anterior body regions, where the inferior alveolar and mental nerves are located, there is limited access which can impede correct reduction and hinder the use of optimal fixation. To counter these problems, better access can be gained through skeletonization of the mental nerve, which is known to result in neurosensory disturbances. However, the extent of neurosensory deficits that may result from these procedures and the degree of their recovery remain unknown in current literature. Objective: The primary purpose of our study was to evaluate and correlate the objective and subjective neurosensory recovery of the mental nerve following skeletonization during Open Reduction and Internal Fixation of mandibular fractures. Study Design: This was a prospective observational study. Settings: The adult subjects having mandibular fractures treated at Jinnah Hospital, Lahore Pakistan, a level III tertiary care hospital. Duration: The study duration was from July 1, 2022 and December 31, 2022. Methods: Demographic details were taken and preoperative objective and subjective neurosensory assessment was performed. Following surgery, postoperative objective and subjective neurosensory assessment was performed on post op day 1, after 1 and 6 weeks. Collected data was analysed with significance level of &lt;0.05. Results: Twenty four subjects who completed regular follow-up visits for 6 weeks were included in this study. All subjects had objective or subjective neurosensory deficit preoperatively. Following surgery, all the subjects had FSR grade S0 and subjective loss of sensation at immediate postoperative assessment after surgery. 87.5% of the subjects had complete objective and subjective neurosensory recovery at the end of 6 weeks. There was a significant negative correlation between objective and subjective neurosensory recovery during the initial stages of the study, which became non-significant by the end of 6 weeks. Conclusion: Following mental nerve skeletonization during ORIF of subjects with mandibular fractures having some degree of preoperative paraesthesia, a majority of subjects achieved complete neurosensory recovery 6 weeks postoperatively. Therefore, it is expected for a skeletonized mental nerve to return to normal function within 2 months after ORIF for mandibular fractures.

Relationship of the Degree of Nerve Exposure and Surgical Manipulation and Short-Term Neurosensory Disturbance Following Sagittal Split Ramus Osteotomy: A Prospective Study

BackgroundNeurosensory disturbance (NSD) is a common complication after sagittal split ramus osteotomy (SSRO) due to inferior alveolar nerve (IAN) injury. The impact of intraoperative nerve manipulation on NSD remains debated. PurposeThe purpose of this study was to evaluate the influence of IAN exposure and manipulation during SSRO on functional sensory recovery (FSR). Study designThis was a single-center, prospective cohort study of 40 patients undergoing SSRO at Mahidol University, from December 2020 to December 2021. The inclusion criteria were patients aged 20-34, ASA Class I-II. The exclusion criteria were patients with systemic bone disease, history of head and neck or neurological pathology, previous SSRO or incomplete data collection. Predictor variableDegree of intraoperative nerve manipulation was divided by the attending surgeon as follows; 1) Nerve fully encased in distal segment and not visible (NS); 2) Nerve encased in distal segment but partially visible (DS) ; 3) Nerve partially encased in proximal segment and fully dissected free (PS). Outcome variablesThe area of interest was divided into the lip and chin. The primary outcome was time to FSR. The secondary outcome was subjective patient report, using a visual analogue scale, compared to FSR. CovariatesThe covariates were sex, age, skeletal diagnosis, degree of movement, and concomitant genioplasty/subapical procedure. AnalysesKaplan-Meier survival analysis, Cox proportional hazards regression, and Mcnemar test were utilized. P-value < 0.05 was significant. ResultsIn the lip, the median times to FSR were; NS, 2 days; DS, 45 days; PS, 102 days. (Interquartile range: 77,127, 114, respectively) In the chin, the median times to FSR were; NS, 23 days; DS, 92 days; PS, 87 days. (Interquartile range: 77, 161, 101, respectively.) Nerve manipulation significantly affected FSR in the lip and chin (p= 0.001, <0.001, respectively. Cox hazard ratios for DS and PS were lower compared to NS. Patients consistently reported more NSD compared to FSR as per Mcnemar test. Conclusion and RelevanceAfter SSRO, FSR in the lip is prolonged when the IAN is partially encased in the proximal segment and released. This raises the question of the efficacy of surgically releasing a partially encased IAN.

Comparison of vertical bone resorption following various types of autologous block bone grafts

BackgroundThis study aims to measure and compare the differences in vertical bone resorption after vertical augmentation using different types of autologous block bone.MethodsData were collected from 38 patients who had undergone vertical ridge augmentation using an autologous block bone before implant insertion. The patients were divided into three groups based on the donor sites: ramus bone (RB), chin bone (CB), and iliac crestal bone (IB).ResultsThe surgical outcome of the augmentation was evaluated at the follow-up periods up to 60 months. In 38 patients, the mean amount of vertical bone gain was 8.36 ± 1.51 mm in the IB group, followed by the RB group (4.17 ± 1.31 mm) and the CB group (3.44 ± 1.08 mm). There is a significant difference in vertical bone resorption between the groups (p < 0.001), and the RB group demonstrated significantly lower resorption than the CB and IB groups (p = 0.011 and p < 0.001, respectively). The most common postoperative complications included neurosensory disturbance in the CB graft and gait disturbance in the IB graft. Out of the 92 implants inserted after augmentation, four implants were lost during the study period, resulting in an implant success rate of 95.65%.ConclusionsThe RB graft might be the most suitable option for vertical augmentation in terms of maintaining postoperative vertical height and reducing morbidity, although the initial gain was greater with the IB graft compared to other block bones.

Patient's perception of recovery following surgical removal of mandibular third molars. A prospective european multi-center study

This study evaluated patient's perception of recovery following surgical removal of mandibular third molars (SRM3s) including analyze of potential risk factors associated with impaired convalescent. Patient related parameters combined with preoperative questionnaires including Modified Dental Anxiety Scale, Oral Health Impact Profile-14, and Decayed, Missing, Filled Teeth index were correlated with questionnaires assessing pain, swelling, trismus, sick leave, social and working isolation, physical appearance, eating and speaking ability, diet variations, sleep impairment, impaired sensation of the lip, chin, and tongue, one month following SRM3s. Totally, 412 patients (223 females, 189 males) with mean age of 29.4 years were included. Treatment satisfaction and willingness to undergo similar surgery were reported by 92% and 95%, although 21% reported that the surgery and postoperative period had been worse than expected. Mean days with pain, sick leave, and swelling were 3.6, 2.1, and 3.6, respectively. Preoperative symptoms, dental anxiety level, and prolonged surgical time were associated with increased pain and swelling (P < 0.05). Pell and Gregory classification (I-IIIC) were associated with impaired sensation of the lower lip and chin (P < 0.05). Consequently, results from this study improve the surgeon's ability to predict parameters that predisposed to impaired recovery and neurosensory disturbances following SRM3s.

Inferior alveolar nerve repositioning surgical techniques and outcomes – a systematic review

Inferior alveolar nerve (IAN) lateralization (IANL) or transposition (IANT) are both techniques allowing for dental implant placement in posterior atrophic mandibles. The aim of this study was to systematically review the implant survival rate and the complications associated with IAN reposition techniques with simultaneous implant placement in atrophic posterior mandibles.This systematic review was conducted following PRISMA guidelines (Preferred Reporting Items for Systematic review and Meta-Analysis). The review was designed to answer the following PICO question: Is IAN repositioning (I) a safe and efficient technique (O) to treat patient looking for fixed dental rehabilitation of an atrophic posterior mandible (P).Thirty-three articles were reviewed, including a total of 899 patients, and approximately 950 IAN repositioning procedures. Dental implant survival rate ranged between 86.95% and 100% with a mean dental survival rate of 90.16%. Among the 269 patients who underwent IANT, there were 93% immediate neurosensory disturbance, and 15% persistent neurosensory disturbance. Among the 350 patients who underwent IANL, there were 93% immediate neurosensory disturbance, and 6% persistent neurosensory disturbance.IANT and IANL are reliable techniques allowing safe dental implant placement in atrophic posterior mandible with high patient satisfaction. IANL seems to cause less persistent neurosensory disturbances compared to IANT. The level of evidence is poor due to the high number of bias present in the included studies. IAN neurosensory disturbance assessment should be better homogenized in order to increase comparability.

Vibration related symptoms and signs in two groups of exposed workers

The aim was to compare the prevalence of vibration related symptoms and signs in two groups of vibration exposed male workers: 36 vibration exposed patients and 33 truck mechanics. All participants answered a questionnaire, passed a structured interview about work and medical history and several neurophysiological tests. The prevalence of vibration white fingers (VWF) and neurosensory symptoms was significantly higher among the exposed patients than among the truck mechanics. One neurosensory examination method identified 46% of the exposed patients with numbness and tingling, three methods up to 85%. In the total material logistic regression showed that age and increased cold sensitivity were significant predictors of both neurosensory disturbances and vibration white fingers. Muscle cramps in arms and hands, pain in hands and age were significant predictors of reduced grip strength. The differences between the two groups were more pronounced for category variables than for continuous variables.