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

Abstract

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 <10 mm; 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 90 days post-diagnosis. Nerve transection diagnosed intra-operatively should be repaired in situ; 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.

Signs and symptoms, quality of life and psychosocial data in 1331 post‐traumatic trigeminal neuropathy patients seen in two tertiary referral centres in two countries

“…A mean duration of 112 days means a referral delay beyond what is considered the therapeutic window of opportunity of 3 months after the injury occurs. 18 Within this window of opportunity, surgical intervention is most likely to be successful. 19,20 In addition, the phenomenon of peripheral and central sensitisation can potentially be arrested within this period.…”

Neurotrophic effects of dental pulp stem cells in repair of peripheral nerve after crush injury

“…Inferior alveolar nerve (IAN) and lingual nerve (LN) injuries are complications of mandibular third molar extraction, which usually lead to numbness of the lips and taste disorder and eventually impose an extremely large burden on the patient’s life[ 1 ]. The IAN and LN can be stretched or crushed during surgical operation[ 2 ], ultimately leading to functional disorder. The incidence of LN injury after third molar surgery varies from 0.4% to 1.5%, while the incidence of IAN injury involvement is approximately 1% to 5%[ 1 ].…”

Immediate or Delayed Transplantation of a Vein Conduit Filled with Nasal Olfactory Stem Cells Improves Locomotion and Axogenesis in Rats after a Peroneal Nerve Loss of Substance

“…Our protocol was based on the minimum time necessary to produce a relatively large quantity of stem cells in GMP conditions and, therefore, allow autologous transplantations. Nevertheless, some nerve injuries can be overlooked for several years [48,49] and it may be wise to assess our therapeutic strategy in long-lasting nerve injuries.…”