Interventions for iatrogenic inferior alveolar and lingual nerve injury

Coulthard, Paul; Kushnerev, Evgeny; Yates, Julian; Walsh, Tanya; Patel, Neil; Bailey, Edmund; Renton, Tara

doi:10.1002/14651858.cd005293.pub2

Cited by 49 publications

(78 citation statements)

References 42 publications

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“…They emphasized targeted treatment modalities according to these subgroups and careful neurophysiologic examinations to distinguish these groups. Also in patients with iatrogenic nerve lesions, targeted treatment modalities were presented in previous studies [9, 46]. A proper use of neurophysiological diagnostic tests seems to offer the possibility for targeted interventions based one the underlying pathophysiological mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome

Hartmann¹,

Seeberger²,

Bittner

et al. 2017

BMC Oral Health

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BackgroundThe aim of the study was to analyse intraoral neurophysiological changes in patients with unilateral lingual nerve lesions as well as patients with Burning Mouth Syndrome (BMS) by applying a standardized Quantitative Sensory Testing (QST) protocol.MethodsThe study included patients suffering from a peripheral lesion of the lingual nerve (n = 4), from BMS (n = 5) and healthy controls (n = 8). Neurophysiological tests were performed in the innervation areas of the tongue bilaterally. For BMS patients the dorsal foot area was used as reference.ResultsFor patients with peripheral lesion of the lingual nerve the affected side of the tongue showed increased thresholds for thermal (p < 0.05–0.001) and mechanical (p < 0.01–0.001) QST parameters, indicating a hypoesthesia and thermal hypofunction. In BMS patients, a pinprick hypoalgesia (p < 0.001), a cold hyperalgesia (p < 0.01) and cold/warmth hypoesthesia (p < 0.01) could be detected.ConclusionsThe results of this study verified the lingual nerve lesion in our patients as a peripheral dysfunction. The profile showed a loss of sensory function for small and large fibre mediated stimuli. A more differentiated classification of the lingual nerve injury was possible with QST, regarding profile, type and severity of the neurologic lesion. BMS could be seen as neuropathy with variable central and peripheral contributions among individuals resulting in chronic pain.

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Section: Discussionmentioning

confidence: 99%

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome

Hartmann¹,

Seeberger²,

Bittner

et al. 2017

BMC Oral Health

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“…20,21 However, the mean time taken to complete the whole operation procedures was shorter than that of previous studies using piezoelectric osteotomy technique (Table 1), and even slightly shorter than that of previous studies using the conventional rotatory instruments. 9,22–24 The occlusal and lingual resistant alveolar bone was removed adequately by this osteotomy method, thus allowed easier and faster tooth luxation and extraction in lingual direction, reduced the surgical difficulty (coronal sectioning or root sectioning) and saved operation time, and avoided adjacent second molar injury. As the buccal plate is much more thicker than lingual plate in the lingual positioned impacted mandibular 3rd molar, 6 applying conventional buccal technique would cause larger surgical trauma and longer operation time than lingual osteotomy.…”

Section: Discussionmentioning

confidence: 99%

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal

Chen

Zheng

et al. 2016

Medicine

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The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ± 0.63, 3.88 ± 0.66(cm), 2.4 ± 0.2(cm), and 23.7 ± 5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.

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“…[64][65][66][67] Other causes found in this case series highlight the importance of understanding the principles of history and examination in patients presenting with neuropathy affecting the trigeminal nerve, and consideration of how the onset of symptoms may be related to the cause. Trigeminal sensory neuropathy may present with hypofunction (partial or complete numbness) or hyperfunction with altered sensation (paraesthesia, dysaesthesia) and/or neuropathic pain (allodynia -pain on touch or hyperalgesia-increased pain with painful stimuli).…”

Section: Discussionmentioning

confidence: 99%

An update on the causes, assessment and management of third division sensory trigeminal neuropathies

et al. 2016

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Introduction Sensory neuropathies of the mandibular division of the trigeminal (V3) nerve can be debilitating, causing difficulty with daily function. It has a variety of causes, including iatrogenic injury, usually caused by third molar removal, local anaesthetic administration, implant placement or endodontic treatment. Non-iatrogenic causes include infection, primary or secondary neoplasia and various medical conditions.Objective To review the aetiology, evaluation and management of V3 neuropathy in a retrospective case-series of patients referred to a specialist nerve injury clinic over an eight-year period, particularly focusing on the non-iatrogenic causes of this presentation.Methods A retrospective analysis of the case notes of 372 patients referred to the specialist nerve injury clinic between 2006 and 2014 was carried out to establish the cause of the neuropathy and subsequent management or referral. The assessment protocol of trigeminal neuropathy used in the clinic is also outlined.Results Most patients (89.5%) presented with neuropathy due to iatrogenic injury. Of the non-iatrogenic causes (10.5%), malignancy accounted for a fifth of presentations, and infection almost two-fifths, demonstrating the importance of prompt identification of a cause and management by the clinician, or referral to the appropriate specialty. Other, more rare causes are also presented, including multiple sclerosis, sickle-cell anaemia and Paget's disease, highlighting the importance to the clinician of considering differential diagnoses.Conclusions This case series demonstrates the less frequent, but nevertheless important, non-iatrogenic causes which clinicians should consider when assessing patients with trigeminal neuropathy.

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Interventions for iatrogenic inferior alveolar and lingual nerve injury

Abstract: Interventions for iatrogenic inferior alveolar and lingual nerve injury (Review)

Cited by 49 publications

References 42 publications

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal

An update on the causes, assessment and management of third division sensory trigeminal neuropathies

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