Abstract
The aims of this study were threefold: (1) to describe iatrogenic lesions to oral branches of the trigeminal nerve, signs and symptoms, and functional status, (2) to report on a simple neurosensory examination method, and (3) to discuss means of prevention of iatrogenic injury. The etiology and functional status of 449 injuries to oral branches collected over 18 years were retrospectively reviewed. A simple scheme of a clinical neurosensory examination was applied to enable a quantified rating of the perception. Injury to the lingual nerve (n = 261) is not only the most prevalent type of lesion, it also seems to be the most devastating type of lesion. Third molar surgery (n = 319) counts for the majority of injuries to the lingual, inferior alveolar, and buccal nerves. Lesions related to the injection of local analgesics was the second most frequent etiology (n = 78), and the lingual nerve was affected more frequently and severely than other oral branches of the trigeminal nerve. The female gender was overrepresented in incidence of injured nerves but no difference was found in the severity of affection between females and males. All grades of loss of neurosensory functions were found, and a range of neurogenic malfunctions was reported. Methodological obstacles in clinical neurosensory examination of trigeminal nerve injury and the magnitude of neurosensory impairment are discussed. Many nerve injuries are avoidable by critical reevaluation of indications, increased awareness of potential hazards, and modified surgical procedures.
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Akal ÜK, Sayan NB, Aydogan S, Yaman Z (2000) Evaluation of the neurosensory deficiencies of oral and maxillofacial region following surgery. Int J Oral Maxillofac Surg 29:331–336
Bartling R, Freeman K, Kraut RA (1999) The incidence of altered sensation of the mental nerve after mandibular implant placement. J Oral Maxillofac Surg 57:1408–1412
Bataineh AB (2001) Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg 59:1012–1017
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
Chaushu G, Taicher S, Halamish-Shani T, Givol N (2002) Medicolegal aspects of altered sensation following implant placement in the mandible. Int J Oral Maxillofac Implants 17:413–415
Cornelius CP, Roser M, Ehrenfeld M (1997) Mikroneurale Wiederherstellung nach iatrogenen Läsionen des N. Lingualis und des N. alveolaris inferior. Kritische Bestandsaufnahme. Mund Kiefer Gesichtschir 1:213–223
Dao TT, Mellor A (1998) Sensory disturbances associated with implant surgery. Int J Prosthodont 11:462–469
Dodson TB, Kaban LB (1997) Recommendations for management of trigeminal nerve defects based on a critical appraisal of the literature. J Oral Maxillofac Surg 55:1380–1386
Fielding AF, Rachiele DP, Frazier G (1997) Lingual nerve paresthesia following third molar surgery. A retrospective clinical study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 84:345–348
Gargallo-Albiol J, Buenechea-Imaz R, Gay-Escoda C (2000) Lingual nerve protection during surgical removal of lower third molars. Int J Oral Maxillofac Surg 29:268–271
Gerlach KL, Hoffmeister B, Walz C (1989) Dysästhesien und Anästhesien des N. mandibularis nach zahnärztlicher Bahandlung. Dtsch Zahnarztl Z 44:970–972
Gomes AC, Vasconcelos BC, de Oliveira e Silva ED, da Silva LC (2005) Lingual nerve damage after mandibular third molar surgery: a randomized clinical trial. J Oral Maxillofac Surg 63:1443–1446
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
Haas DA, Lennon D (1995) A 21 year retrospective study of reports of paresthesia following local anaesthetic administration. J Can Dent Assoc 61:319–330
Handschel J, Figgener L, Joos U (2001) Die forensische Bewertung von Verletzungen der Nerven und des Kieferknochens nach Weisheitszahnentfernungen im Blickwinkel der aktuellen Rechtsprechung. Mund Kiefer Gesichtschir 5:44–48
Harn SD, Durham TM (1990) Incidence of lingual nerve trauma and postinjection complications in conventional mandibular block anaesthesia. J Am Dent Assoc 121:519–523
Hillerup S, Hjørting-Hansen E, Reumert T (1994) Repair of the lingual nerve after iatrogenic injury: a follow-up study of return of sensation and taste. J Oral Maxillofac Surg 52:1028–1031
Hillerup S, Jensen R (2001) Iatrogene nerveskader opstået i almen tandlægepraksis. Hyppighed, årsager og symptomer. Tandlaegebladet 105:614–622
Hillerup S, Jensen R (2006) Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg 35:437–443
Krafft TC, Hickel R (1994) Clinical investigation into the incidence of direct damage to the lingual nerve caused by local anaesthesia. J Craniomaxillofac Surg 22:294–296
Kraut RA, Chahal O (2002) Management of patients with trigeminal nerve injuries after mandibular implant placement. J Am Dent Assoc 133:1351–1354
LaBanc JP, Gregg JM (1992) Trigeminal nerve injuries. Basic problems, historical perspectives, early successes, and remaining challenges. In: LaBanc JP, Gregg JM (eds) Oral and maxillofacial surgery clinics of North America. Saunders, Philadelphia, pp 277–283
Loescher AR, Smith KG, Robinson PP (2003) Nerve damage and third molar removal. Dent Update 30:375–380
Lydiatt DD (2003) Litigation and the lingual nerve. J Oral Maxillofac Surg 61:197–200
Mason DA (1988) Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 17:290–294
Pogrel MA, Lee JS, Muff DF (2004) Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg 62:1447–1452
Pogrel MA, Thamby S (2004) Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Am Dent Assoc 131:901–907
Renton T, McGurk M (2001) Evaluation of factors predictive of lingual nerve injury in third molar surgery. Br J Oral Maxillofac Surg 39:423–428
Robinson PP (1988) Observations on the recovery of sensation following inferior alveolar nerve injuries. Br J Oral Maxillofac Surg 26:177–189
Robinson PP, Loescher AR, Smith KG (2000) A prospective, quantitative study on the clinical outcome of lingual nerve repair. Br J Oral Maxillofac Surg 38:255–263
Robinson PP, Smith KG (1996) A study of the efficacy of late lingual nerve repair. Br J Oral Maxillofac Surg 34:96–103
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
Robinson PP, Smith KG, Johnson FP, Coppins DA (1992) Equipment and methods for simple sensory testing. Br J Oral Maxillofac Surg 30:387–389
Rood JP, Shehab BAA (1990) The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 28:20–25
Sandstedt P, Sörensen S (1995) Neurosensory disturbances of the trigeminal nerve: a long-term follow-up of traumatic injuries. J Oral Maxillofac Surg 53:498–505
Sunderland S (1991) Nerve injury and sensory function. In: Sunderland S (ed) Nerve injuries and their repair: a critical appraisal. Churchill Livingstone, Edinburgh, pp 305–332
Teerijoki-Oksa T, Jääskiläinen SK, Forsell K, Virtanen A, Forsell H (2003) An evaluation of clinical and electrophysiological tests in nerve injury diagnosis after mandibular sagittal split osteotomy. Int J Oral Maxillofac Surg 32:1523
Venta I, Lindqvist C, Ylipaavalniemi P (1998) Malpractice claims for permanent nerve injuries related to third molar removals. Acta Odontol Scand 56:193–196
Walters H (1995) Reducing lingual nerve damage in third molar surgery: a clinical audit of 1350 cases. Br Dent J 25:140–144
Westermark A (1999) On inferior alveolar nerve function after sagittal split osteotomy of the mandible. Thesis, Kongl Carolinska Medico ChirurGiska Institutet, Stockholm, pp 1–49
Wismeijer D, van Waas MA, Vermeeren JI, Kalk W (1997) Patients’ perception of sensory disturbances of the mental nerve before and after implant surgery: a prospective study of 110 patients. Br J Oral Maxillofac Surg 35:254–259
Worthington P (2004) Injury to the inferior alveolar nerve during implant placement: a formula for protection of the patient and clinician. Int J Oral Maxillofac Implants 19:731–734
Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF (1998) The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg 56:2–8
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Appendix
Appendix
Applied neurological terms in alphabetic order
- Ageusia:
-
absence of gustatory perception
- Allodynia:
-
pain due to a stimulus that is not normally painful when applied elsewhere to the body
- Anesthesia:
-
insensitivity to all forms of stimulation
- Analgesia:
-
absence of pain in response to stimulation that should normally be painful
- Dysgeusia:
-
distorted gustatory perception
- Dysesthesia:
-
any unpleasant abnormal sensation, either spontaneous or evoked, used in this study to describe painful paresthesia and burning neurogenic discomfort and pain
- Hypesthesia:
-
diminished sensitivity to all forms of stimulation
- Hyperesthesia:
-
increased sensitivity to all forms of stimulation
- Paresthesia:
-
unusual, abnormal but not painful, spontaneous or evoked sensations (tingling or pricking sensation)
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Hillerup, S. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Invest 11, 133–142 (2007). https://doi.org/10.1007/s00784-006-0089-5
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DOI: https://doi.org/10.1007/s00784-006-0089-5