Lingual Nerve Morbidity and Mandibular Third Molar Surgery: A Prospective Study

Abstract

<i>Objective:</i> The objective of this study was to estimate the frequency of postoperative lingual nerve (LN) impairment after the surgical removal of mandibular third molars (M3) and to identify potential risk indicators. <i>Subjects and Methods:</i> A prospective cohort study involving 321 subjects who had 443 mandibular M3 surgically extracted at the University Hospital, Amman, Jordan. Predictor variables were categorized as patient-, anatomy- and operation-specific. The outcome variable was the presence or absence of LN impairment. Bivariate and multivariate analyses were performed to identify independent predictors. <i>Results:</i> The prevalence of temporary LN hypoesthesia was 2.5% and all 11 cases resolved within 6 months. Factors that predicted LN injury by univariate analysis were horizontal and mesioangular tooth angulation, bone removal, tooth sectioning, longer operations, lingual flap retraction and bleeding into the socket. In the multivariate logistic regression model, lingual flap retraction (p = 0.002, OR = 26.790) and bleeding into the socket (p = 0.044, OR = 4.918) were the independent predictors. <i>Conclusion:</i> Operative variables were the main predictors of temporary LN damage.

Factors Influencing Lingual Nerve Paraesthesia Following Third Molar Surgery: A Prospective Clinical Study

“…In the present study LNI occurred in cases which took longer time for the operation. This is in accordance with the observations of few previous studies [21,23].…”

“…But adjacent to lower third molar lingual nerve is covered with only a thin layer of soft tissue and mucosa increasing the chances of injury [8,23]. Significantly higher LNI occurred in cases where lingual flap was retracted in the present study.…”

“…Significantly higher LNI occurred in cases where lingual flap was retracted in the present study. Several studies have shown that raising and retraction of a lingual mucoperiosteal flap is associated with an increased frequency of lingual nerve damage [10,[21][22][23][24]. Few recent studies and a systematic review have concluded that retraction of lingual periosteal flap is not necessary and can be avoided during third molar surgery [25,26].…”

Comparison of Subjective and Objective Assessments of Neurosensory Function after Lingual Nerve Repair

“…The prevalence of temporary lingual nerve hypoesthesia after third molar extraction is between 2.1 and 2.5% [1-3]. The majority of the reported disturbances completely subsided during the follow-up period.…”

Morphology and Morphometry of the Lingual Nerve in Relation to the Mandibular Third Molar

“…LN damage may be related to the variant anatomy in the course of the nerve and use of different surgical techniques [7] resulting in significant morbidity to the patient [8] and potential medico-legal repercussion to the surgeon [9]. Data on the LN are especially useful to new practitioners since it has been shown that inexperience on the part of the practitioner is an important factor leading to LN injury [10].…”