Lingual nerve injury during extraction of mandibular third molars:  Are we extracting correctly?

Muhammad Israr; Muhammad Adil Asim; Abdul Rehman Israr

doi:10.32593/jstmu/Vol5.Iss2.209

Muhammad Israr Oral & Maxillofacial Surgery, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan
Muhammad Adil Asim Oral & Maxillofacial Surgery, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan
Abdul Rehman Israr Department of Dentistry, Rehman College of Dentistry, Peshawar, Pakistan

DOI: https://doi.org/10.32593/jstmu/Vol5.Iss2.209

Keywords: Mandibular third molar, Lingual nerve, Mucoperiosteal flap, ostectomy

Abstract

Introduction: Neurological injuries including lingual nerve damage are among the most devastating complications of mandibular third molar extraction. Various causes of lingual nerve damage have been proposed in literature including the surgical technique.

Objective: This study aims to assess the adverse outcomes of the removal of mandibular third molars in terms of the frequency of lingual nerve injury (LNI).

Methodology: This prospective case series was carried out at Maroof International Hospital, Islamabad. Surgical extraction was performed after raising both lingual and buccal mucoperiosteal flaps for surgical access. Ostectomy and tooth sectioning was performed while protecting the lingual flap with a passively placed periosteal elevator. Patients were recalled for the assessment of lingual nerve status, one week postoperatively.

Results: Out of the total of 1487 teeth extracted temporary lingual nerve injury was observed in just two cases (0.13%) both of which were extracted because of recurrent pericoronitis. None of the patients had a permanent neurological deficit.

Conclusion: For improving civility in nursing college, insight into incivility among students and faculty members is to be developed and policies to be in place to address unacceptable behaviors in a timely and effective manner. A surgical technique using careful lingual flap elevation and passive retraction results in the prevention of iatrogenic lingual nerve injury.

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Author Biographies

Muhammad Israr, Oral & Maxillofacial Surgery, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Professor

Muhammad Adil Asim, Oral & Maxillofacial Surgery, Shifa College of Dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan

Assistant Professor

Abdul Rehman Israr, Department of Dentistry, Rehman College of Dentistry, Peshawar, Pakistan

Scholar

References

La Monaca G, Vozza I, Giardino R, Annibali S, Pranno N, Cristalli MP. Prevention of neurological injuries during mandibular third molar surgery: technical notes. Ann Stomatol (Roma). 2017; 8(2):45-52.

DOI: https://doi.org/10.11138/ads/2017.8.2.053

Ghabriel M, Takezawa K, Townsend G. The lingual nerve: overview and new insights into anatomical variability based on fine dissection using human cadavers. Odontology. 2019; 107(1):1-9.

DOI: https://doi.org/10.1007/s10266-018-0371-4.

Pippi R, Spota A, Santoro M. Prevention of Lingual Nerve Injury in Third Molar Surgery: Literature Review. J Oral Maxillofac Surg. 2017; 75(5):890-900.

DOI: https://doi.org/10.1016/j.joms.2016.12.040

Bailey E, Kashbour W, Shah N, Worthington HV, Renton TF, Coulthard P. Surgical techniques for the removal of mandibular wisdom teeth. Cochrane Database Syst Rev. 2020; 7(7): CD004345.

DOI: https://doi.org/10.1002/14651858.CD004345.pub2.

Malamed SF. Handbook of local anesthesia. 7th ed. St. Louis: Mosby; 2020. pp. 239-249

Sawadogo A, Coulibaly M, Quilodran C, Bationo R, Konsem T, Ella B. Success rate of first attempt 4% articaine para-apical anesthesia for the extraction of mandibular wisdom teeth. J Stomatol Oral Maxillofac Surg. 2018; 119(6):486-488.

DOI: https://doi.org/10.1016/j.jormas.2018.06.005.

Pogrel MA, Schmidt BL, Sambajon V, Jordan RC. Lingual nerve damage due to inferior alveolar nerve blocks: a possible explanation. J Am Dent Assoc. 2003; 134(2):195-9.

DOI: https://doi.org/10.14219/jada.archive.1995.0336

Kim C, Hwang KG, Park CJ. Local anesthesia for mandibular third molar extraction. J Dent Anesth Pain Med. 2018; 18(5):287-294.

DOI: https://doi.org/10.17245/jdapm.2018.18.5.287.

Klazen Y, Van der Cruyssen F, Vranckx M, Van Vlierberghe M, Politis C, Renton T, et al. Iatrogenic trigeminal post-traumatic neuropathy: a retrospective two-year cohort study. Int J Oral Maxillofac Surg. 2018; 47(6):789-793.

DOI: https://doi.org/10.1016/j.ijom.2018.02.004

Hopman AJ, Baart JA, Brand HS. Articaine and neurotoxicity–a review. Br Dent J. 2017; 223(7):501-6.

DOI: https://doi.org/10.1038/sj.bdj.2017.782

Stirrup P, Crean S. Does articaine, rather than lidocaine, increase the risk of nerve damage when administered for inferior alveolar nerve blocks in patients undergoing local anesthesia for dental treatment? A mini systematic review of the literature. Br Dent J. 2019; 226, 213–223.

DOI: https://doi.org/10.1038/sj.bdj.2019.98

Renton T, Adey-Viscuso D, Meechan JG, Yilmaz Z. Trigeminal nerve injuries about the local anesthesia in mandibular injections. Br Dent J. 2010; 209(9): E15.

DOI: https://doi.org/10.1038/sj.bdj.2010.978.

Sushmitha M, Thangavelu A, Aravindraj. Lingual split bone technique – Revisited as a standard operating procedure for surgical removal of the third molar during the COVID pandemic. J Acad Dent Educ. 2021; 7(1):18-22.

DOI: https://doi.org/10.25259/JADE_3_2021

Sprunk EA, LaSala KB, Wilson VL. Student incivility: Nursing faculty lived experience. J Nurs Educ Pract.2014; 4(9):1.

DOI: https://doi.org/10.5430/jnep.v4n9p1

Petroni G, Passaretti A, Zaccheo F, Di Nardo D, Testarelli L, Cicconetti A. Lingual Flap Protection during Third Molar Surgery: A Literature Review. Eur J Dent. 2021; 15(4):776-781.

DOI: https://doi.org/10.1055/s-0041-1730042.

Ramadorai A, Tay ABG, Vasanthakumar G, Lye WK. Nerve Injury After Surgical Excision of Mandibular Third Molars Under Local Anesthesia: An Audit. J Maxillofac Oral Surg. 2019; 18(2):307-313.

DOI: https://doi.org/10.1007/s12663-018-1151-y.

Rapaport BHJ, Brown JS. A systematic review of lingual nerve retraction during surgical mandibular third molar extractions. Br J Oral Maxillofac Surg. 2020; 58(7):748-752.

DOI: https://doi.org/10.1016/j.bjoms.2020.02.022.

Charan Babu HS, Reddy PB, Pattathan RK, Desai R, Shubha AB. Factors influencing lingual nerve paraesthesia following third molar surgery: a prospective clinical study. J Maxillofac Oral Surg. 2013; 12(2):168-72.

DOI: https://doi.org/10.1007/s12663-012-0391-5.

Jain N, Thomas S, Prabhu S, Jain S, Pathak AD, Pillai A, et al. Influence of tooth sectioning technique and various risk factors in reducing the IAN injury following surgical removal of an impacted mandibular third molar. Oral Maxillofac Surg. 2016; 20(2):149-56.

DOI: https://doi.org/10.1007/s10006-015-0540-3.

Dalle Carbonare M, Zavattini A, Duncan M, Williams M, Moody A. Injury to the inferior alveolar and lingual nerves in successful and failed coronectomies: systematic review. Br J Oral Maxillofac Surg. 2017; 55(9):892-898.

DOI: https://doi.org/10.1016/j.bjoms.2017.09.006.

Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Lingual nerve damage after third lower molar surgical extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90(5):567-73.

DOI: https://doi.org/10.1067/moe.2000.110034.