Inferior Alveolar Nerve Injury after Mandibular Third Molar Extraction: a Literature Review

Sarikov, Rafael; Juodžbalys, Gintaras

doi:10.5037/jomr.2014.5401

Cited by 111 publications

(122 citation statements)

References 63 publications

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“…Risk factors for IAN deficit include increased age, unerupted tooth, deep impaction, specific radiographic signs and intraoperative IAN exposure, all of which are relevant to this case. This risk is again further increased if the tooth is fully encased by bone and the root apices extend below the neurovascular bundle; again relevant to this case. Incidence of lingual nerve damage during third molar surgery can be between 0.1–22%.…”

Section: Discussionmentioning

confidence: 92%

“…Recent literature reviews cite the incidence of IAN injury as 0.35-8.4% following lower third molar extraction. However, 96% of damaged IANs fully recover within 4-8 weeks 12 . Risk factors for IAN deficit include increased age, unerupted tooth, deep impaction, specific radiographic signs and intraoperative IAN exposure 13 , all of which are relevant to this case.…”

Section: Discussionmentioning

confidence: 98%

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The use of 3D model planning in the management of impacted teeth

2018

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The extraction of deeply impacted mandibular wisdom teeth can be challenging and may pose a risk of damage to the Inferior Alveolar Nerve (IAN). Thorough planning helps minimise this risk whilst improving the efficiency of the surgical procedure. The use of modern imaging and modelling techniques can help mitigate this risk and improve outcomes. We discuss the case of a 61 year old male presenting to the outpatients department complaining of facial swelling and limited mouth opening. Plain film imaging revealed a deeply impacted molar with associated pathology. Subsequent 3D imaging provided more accurate location of the tooth and the close association with the IAN. Surgical planning included the construction of a 3D model of the mandible. A viewing window was created to observe both the tooth and nerve. The construction and customisation of the model allowed for practise surgery along with appropriate preoperative decision making. An acrylic guide was constructed to fit the mandible intraoperatively and guide the bone cuts in the correct position, relative to the unerupted tooth. The surgery was performed successfully using the guide intraoperatively. The tooth was removed without traumatising the IAN. The patient has since made a rapid and complete recovery after surgery with no neurosensory defect noted.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

The use of 3D model planning in the management of impacted teeth

2018

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“…However, in a literature review of prospective studies, it was found that age is linked to IAN and lingual nerve deficits and it was the first etiology even before deep impaction, specific radiographic signs, intra-operative IAN exposure and lingual split technique [36]. For Sarikov and Juodzbalys [37] more risks for subjects older than 24 years. Probably, other anatomic and physiologic factors could be involved in having these clinical findings.…”

Section: Discussionmentioning

confidence: 99%

Classification of impacted mandibular third molars using cone beam computed tomography based on neurological risks: N.R.C.

Nemsi

Tellili

Bouanène

et al. 2017

Med Buccale Chir Buccale

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--Introduction: Considering the close proximity of the third molar roots and the mandibular canal, also the location of the lingual nerve and its anatomic variations, both nerves may be injured during extraction. The aim of this observational study was to optimize a classification of the relationship between the third molar and its neuroanatomical environment, mandibular canal and lingual bone plate, which is inspired from the neurological risks involving cone beam CT (CBCT) images, and to apply this classification to our sample. Materials and methods: A retrospective, observational study was performed involving 100 CBCT (171 mandibular third molars). Two medical doctors, qualified in human anatomy, independently evaluated all CBCT using coronal oblique sections. The classification was approved by agreement between both observers. After that, it was applied to our sample by one of them. The SPSS software, version 21.0 (SPSS® Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results: The final consensual classification presented three Classes (A, B, L) with their four subclasses (from 1 to 4). The rare cases found in our sample were grouped separately under the name of "uncommon", and were divided into four specific subclasses. The status of the lingual bone plate was assessed by the presence or the absence of a fenestration or a cortical thinning. In the current study, when the mandibular canal presented a direct contact with the third molar with a reduced calibre, lingual course was the most frequent anatomical situation in both genders (males 66.7%/ females 70.5%). There is not a significant correlation between the proximity of the third molar to the mandibular canal neither with age nor with gender. In contrast, the proximity to the third molar is significantly associated with the course of the canal. The highest significance was found with the lingual course. Statistical analysis showed a nonsignificant correlation between the status of the lingual bone plate and the age then the gender. Discussion and conclusion: The use of the proposed classification (NRC) could be a support for clinical practice. We suggested a common language among operators and during collaboration with radiologists in order to facilitate the clinical discussion and to correlate the surgery outcomes to the CBCT classes for more adjustment of the surgical procedures.

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“…1 Due to the close anatomic relation between lower third molars and mandibular canal, odontectomy of impacted lower third molars carry potential risk for injury of inferior alveolar nerve. 2 Injury of inferior alveolar nerve may be due to trauma, inflammation or infection in the periphery of the nerve manifesting clinically as reduced sensation, or paraesthesia, of lower lip and chin of the affected sides.…”

Section: Introductionmentioning

confidence: 99%