Abstract
Purpose
Injuries of the inferior alveolar nerve (IAN) related to endodontic treatment are being increasingly reported. However, consensus on the preferred intervention and the timing of and indications for surgical treatment is lacking. Here, we describe our experience with painful IAN injuries arising from endodontic treatment and requiring prompt microsurgical treatment.
Methods
Seven consecutive patients with painful IAN injuries were referred to the Maxillofacial Surgery Unit of San Paolo Hospital in Milan. All patients had undergone root canals endodontic treatment in the mandibular molar or premolar between 2007 and 2014. The time elapsed between injury and referral for surgical treatment ranged from 10 days to 20 months. Each patient was treated by one of several different microsurgical procedures, described herein.
Results
Overall, neurosensory status and IAN-related pain improved in all seven patients. The best results were obtained by IAN replacement with a sural nerve graft. However, complete sensory recovery was not achieved in any of the patients.
Conclusions
Although our sample includes only seven patients, early surgical treatment with an interpositional sural nerve graft seems to allow neurosensory recovery. Less satisfactory results are achieved in patients with IAN injuries of > 12 months duration.
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References
Biglioli F, Allevi F, Lozza A (2015) Surgical treatment of painful lesions of the inferior alveolar nerve. J Craniomaxillofac Surg 43:1541–1545. https://doi.org/10.1016/j.jcms.2015.07.036
Pogrel MA (2007) Damage to the inferior alveolar nerve as the result of root canal therapy. J Am Dent Assoc 138:65–69
Renton T (2013) Nonsurgical management of trigeminal nerve injuries. In: Miloro (ed) Trigeminal nerve injuries. Springer, Berlin Heidelberg, pp 213–227
Alves FR, Coutinho MS, Gonçalves LS (2014) Endodontic-related facial paresthesia: systematic review. J Can Dent Assoc 80:e13
Coulthard P, Kushnerev E, Yates JM, Walsh T, Patel N, Bailey E, Renton TF (2014) Interventions for iatrogenic inferior alveolar and lingual nerve injury. Cochrane Database Syst Rev 16:CD005293. https://doi.org/10.1002/14651858.CD005293.pub2 Review
Nizam SA 2nd, Ziccardi VB (2015) Trigeminal nerve injuries: avoidance and management of iatrogenic injury. Oral Maxillofac Surg Clin North Am 27:411–424. https://doi.org/10.1016/j.coms.2015.04.006
Monsell E (2005) Iatrogenic facial nerve injury: prevention and management. In: Elsevier (ed) Neurotology Second Edition, Elsevier, pp 1270–1278
Ruggiero SL, Proothi M (2013) Guidelines for diagnosis and treatment of trigeminal nerve injuries. In: Miloro (ed) Trigeminal nerve injuries. Springer, Berlin Heidelberg, pp 343–359
Knowles KI, Jergenson MA, Howard JH (2003) Paraesthesia associated with endodontic treatment of mandibular premolars. J Endod 29:768–770
Renton T, Yilmaz Z (2011) Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain 25:333–344
Cronström R, Owall B, René N (1998) Treatment injuries in dentistry—cases from one year in the Swedish Patient Insurance Scheme. Int Dent J 48:187–195
Zuniga JR, LaBanc JP (1993) Advances in microsurgical nerve repair. J Oral Maxillofac Surg 51:62–68
Cornelius CP, Roser M, Ehrenfeld M (1997) Microneural reconstruction after iatrogenic lesions of the lingual nerve and the inferior alveolar nerve. Critical evaluation. Mund Kiefer Gesichtschir 1:213–223
Kushnerev E, Yates JM (2015) Evidence-based outcomes following inferior alveolar and lingual nerve injury and repair: a systematic review. J Oral Rehabil 42:786–802. https://doi.org/10.1111/joor.12313
Veitz-Keenan A, Keenan JR (2015) Trials needed to identify best management of iatrogenic inferior alveolar and lingual nerve injuries. Evid Based Dent 16:29. https://doi.org/10.1038/sj.ebd.6401085
Bagheri SC, Meyer RA, Cho SH, Thoppay J, Khan HA, Steed MB (2012) Microsurgical repair of the inferior alveolar nerve: success rate and factors that adversely affect outcome. J Oral Maxillofac Surg 70:1978–1990. https://doi.org/10.1016/j.joms.2011.08.030
Bagheri SC, Meyer RA, Khan HA, Kuhmichel A, Steed MB (2010) Retrospective review of microsurgical repair of 222 lingual nerve injuries. J Oral Maxillofac Surg 68:715–723. https://doi.org/10.1016/j.joms.2009.09.111
Biglioli F, Allevi F, Colletti G, Lozza A (2015) Cross-tongue procedure: a new treatment for long-standing numbness of the tongue. Br J Oral Maxillofac Surg 53:880–882. https://doi.org/10.1016/j.bjoms.2015.09.001
Grotz KA, Al-Nawas B, de Aguiar EG, Schulz A, Wagner W (1998) Treatment of injuries to the inferior alveolar nerve after endodontic procedures. Clin Oral Investig 2:73–76
Yaltirik M, Ozbas H, Erisen R (2002) Surgical management of overfilling of the root canal: a case report. Quintessence Int 33:670–672
Woolf CJ (2011) Central sensitization: implications for the diagnosis and treatment of pain. Pain 152:S2–15. https://doi.org/10.1016/j.pain.2010.09.030 Review
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The article, being a retrospective case series, was granted exemption from the Internal Review Board of our institution, the San Paolo Hospital, Milan, Italy. We received an informed consent from all patient included in this study.
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Biglioli, F., Kutanovaite, O., Autelitano, L. et al. Surgical treatment of painful inferior alveolar nerve injuries following endodontic treatment: a consecutive case series of seven patients. Oral Maxillofac Surg 21, 461–466 (2017). https://doi.org/10.1007/s10006-017-0656-8
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DOI: https://doi.org/10.1007/s10006-017-0656-8