Abstract
Background
Injury of the inferior alveolar nerve (IAN) sustained during surgical removal of an impacted lower third molar may cause paresthesia of the lower lip, chin, lower gingivae and anterior teeth. Lingual nerve (LN) injuries may result in ipsilateral paresthesia of the anterior two thirds of the tongue, mucosa of floor of mouth and lingual gingivae. A close anatomic relationship between the roots of the third molar and mandibular canal places the IAN at risk of damage.
Purpose
The primary aim of this retrospective audit was to ascertain the incidence of IAN and LN damage after mandibular third molar surgery in National Dental Centre Singapore. A secondary aim was to identify the contributory factors for the risk of IAN and LN nerve injury on the basis of the data collected.
Methods
This retrospective audit included 1276 mandibular third molar surgical removals performed in the local anesthesia operating theatre (LAOT) at the National Dental Centre Singapore (NDCS) from April to December 2013. Data included patient details, clinical characteristics, and 1 week postoperative presence/absence of sensory alteration as reported by the patient.
Results
Summary of results- Out of 1276 third molar sites audited, 8 (0.62%) sites had altered sensation of the IAN and 1 (0.078%) had altered sensation of the LN at 1 week postoperative review.
Conclusion
The incidence of IAN injury (0.62%) and lingual Nerve injury (0.08%) after one week from surgery in our audit was low compared to similar studies. This retrospective audit did not show any correlation of nerve injury to age, gender, race, site, angulation of tooth, grade of operator, removal of bone or tooth division. There was no single radiological sign associated with paresthesia, although the most common radiological signs were interruption of the canal line and darkening of the roots.
Similar content being viewed by others
References
Osborn TP, Frederickson G, Small IA, Torgerson TS (1985) A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg 43:767–769
Wofford DT, Miller RI (1987) Prospective study of dysesthesia following odontectomy of impacted mandibular third molars. J Oral Maxillofac Surg 45:15–19
Rood JP (1992) Permanent damage to inferior alveolar and lingual nerves during the removal of impacted mandibular third molars. Comparison of two methods of bone removal. Br Dent J 172:108–110
Carmichael FA, McGowan DA (1992) Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group Study. Br J Oral Maxillofac Surg 30:78–82
Schultze-Mosgau S, Reich RH (1993) Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and of recovery of sensitivity. Int J Oral Maxillofac Surg 22:214–217
Brann CR, Brickley MR, Shepherd JP (1999) Factors influencing nerve damage during lower third molar surgery. Br Dent J 186:514–516
Gulicher D, Gerlach KL (2001) Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofac Surg 30:306–312
Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2001) Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92:377–383
Bataineh AB (2001) Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg 59:1012–1017
Mason DA (1988) Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 17:290–294
Blackburn CW, Bramley PA (1989) Lingual nerve damage associated with the removal of lower third molars. Br Dent J 167:103–107
Robinson PP, Smith KG (1996) Lingual nerve damage during lower third molar removal: a comparison of two surgical methods. Br Dent J 180:456–461
Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2000) Lingual nerve damage after third lower molar surgical extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:567–573
Sisk AL, Hammer WB, Shelton DW, Joy ED Jr (1986) Complications following removal of impacted lower third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 44:855–859
Smith WP (2013) The relative risk of neurosensory deficit following removal of mandibular third molar teeth: the influence of radiography and surgical technique. Oral Surg Oral Med Oral Pathol Oral Radiol 115(1):18–24
Rafel S, Gintaras J (2014) Inferior alveolar nerve injury after mandibular third molar extraction: a literature review. J Oral Maxillofac Res 5(4):e1. https://doi.org/10.5037/jomr.2014.5401. URL: http://www.ejomr.org/JOMR/archives/2014/4/e1/v5n4e1ht.pdf
Tay AB, Go WS (2004) Effect of exposed inferior alveolar neurovascular bundle during surgical removal of impacted lower third molars. J Oral Maxillofac Surg 62(5):592–600. https://doi.org/10.1016/j.joms.2003.08.033
Kim JW, Cha IH, Kim SJ, Kim MR (2012) Which risk factors are associated with neurosensory deficits of inferior alveolar nerve after mandibular third molar extraction? J Oral Maxillofac Surg 70(11):2508–2514. https://doi.org/10.1016/j.joms.2012.06.004
Jhamb A, Dolas RS, Pandilwar PK, Mohanty S (2009) Comparative efficacy of spiral computed tomography and orthopantomography in preoperative detection of relation of inferior alveolar neurovascular bundle to the impacted mandibular third molar. J Oral Maxillofac Surg 67(1):58–66
Umar G, Obisesan O, Bryant C, Rood JP (2013) Elimination of permanent injuries to the inferior alveolar nerve following surgical intervention of the “high risk” third molar. Br J Oral Maxillofac Surg 51:353–357
Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C (2001) Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92(4):377–383
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ramadorai, A., Tay, A.B.G., Vasanthakumar, G. et al. Nerve Injury After Surgical Excision of Mandibular Third Molars Under Local Anesthesia: An Audit. J. Maxillofac. Oral Surg. 18, 307–313 (2019). https://doi.org/10.1007/s12663-018-1151-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12663-018-1151-y