Injuries of the Peripheral Mandibular Nerve, Evaluation of Interventions and Outcomes: A Systematic Review

Abstract

Trigeminal nerve injuries are common and there is currently no consensus on both timing and type of intervention to achieve the best outcomes. A systematic review was performed to compare the outcomes of the many different types of therapeutic interventions for nerve injury. PubMed, EBSCO, and Cochrane Review databases were used to search for studies published from January 1, 2000 to December 31, 2019. Included studies detailed treatment of an injury to peripheral branches of the trigeminal nerve, either known transection or injury causing persistent alteration in sensation. The primary outcome was functional sensory recovery via the Medical Research Council scale. Twenty studies were included, detailing outcomes of 608 subjects undergoing intervention for 622 nerve injuries. Surgical interventions were able to achieve functional sensory recovery in approximately >80% or more of the subjects. There was heterogeneity among how procedures were performed, timing to intervention, and methods of measuring recovery. The data of this study supports the ability of surgical intervention to achieve functional sensory recovery in a significant number of subjects, and found evidence for better outcomes with intervention closer to the time of injury.

Effectiveness of concentrated growth factor and laser therapy on wound healing, inferior alveolar nerve injury and periodontal bone defects post‐mandibular impacted wisdom tooth extraction: A randomized clinical trial

“…These facts suggest nerve repair is sophisticated and needs a long time 34 . Some researchers recommended surgery when neurosensory deficits showed no improvement 90 days post‐diagnosis 30 . Our study suggested that the significantly positive effect of CGF and laser treatments can be an alternative to surgery to some degree.…”

“…; it has been widely used in the clinic and has achieved certain curative effect, but the efficacy is not good for patients with severe nerve damage. 29,30 CGF is a kind of gel extracted from patients' venous blood, which is rich in various growth factors. The technology for CGF clinical application is mature, so it is widely used in alveolar surgery and implant surgery which need soft and hard tissue increment.…”

“…Drug therapy means taking neurotrophic drugs such as mecobalamin and vitamins orally, as well as corticosteroid hormones in order to relieve the pressure of the nerve bundle due to oedema; physical therapy is to promote the recovery of the nerve by means of laser, ultrashort wave, ultrasound, acupuncture, etc. ; it has been widely used in the clinic and has achieved certain curative effect, but the efficacy is not good for patients with severe nerve damage 29,30 …”

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review

“…Injury to the IAN and LN during and after MTM surgery can have a variety of causes, including direct trauma to the nerve from rotating instruments during ostectomy or separation, sharp transection during flap preparation, or more indirect damage from compression or chemical disturbance from a hematoma or injection of local anesthetics [ 28 , 29 , 30 , 31 ]. Apart from complete transection of a nerve, which is usually noticed immediately during surgery, it is often difficult to determine the exact cause of nerve injury.…”

“…In symptomatic patients who do not show signs of improvement over time, surgical exploration and, if needed, intervention must be discussed. The overall outcome, as measured by functional sensory recovery, is acceptable, and quality of life can often be increased [ 31 ]. While some authors recommend waiting 90 days for spontaneous healing, recent research suggests improved outcomes after early intervention [ 38 , 39 ].…”