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PubMedDate not supplied

Trigeminal nerve injuries after mandibular implant placement--practical knowledge for clinicians.

Endosseous mandibular implant placement can result in injuries to the peripheral branches of the trigeminal nerve even with the most careful preoperative planning and intraoperative technique. In the past, many patients have been discouraged from seeking repair for such injuries because of the unreliability of the techniques for correcting the injury. It is now possible to perform microneurosurgical repair of such injuries. If the repair is done in a timely fashion, sensation can be improved or restored and painful nerve dysesthesia can be relieved. This article reviews the different types of nerve injuries, their symptoms and diagnosis, and provides information for clinicians to manage their implant patients with neurosensory disturbance.

Dental Implantation, Endosseous↗
PubMed1991

Electrophysiologic investigation of mandibular nerve injury.

Isolated lesions of the mandibular branch of the trigeminal nerve have only rarely been reported. We report the occurrence of an isolated lesion of the mandibular nerve associated with a unilateral mandibular fracture, and its substantiation electrophysiologically. A 65-year-old man was involved in a motor vehicle accident resulting in multiple fractures, including a unilateral mandibular fracture and temporomandibular joint dislocation. No evidence of intracranial pathology by CT scan was noted and the neurologic examination was nonfocal except for dysfunction of the mandibular nerve ipsilateral to the fracture site. Bilateral facial nerve latency and blink reflexes were normal. EMG evaluation of the muscles of facial expression and mastication demonstrated denervation confined to the muscles innervated by the mandibular branch of the trigeminal nerve. In patients complaining of facial sensory dysfunction, malocclusion, or weakness of muscles of mastication after mandibular fracture, an electrophysiologic examination can assist in evaluating cranial nerve integrity.

Aged↗
PubMed1986

Prevention of tongue prolapse by immediate stabilization in severely avulsed mandibular war injuries.

A significantly successful procedure for tongue stabilization, used in six cases of severe war injuries to the mandible, which prevents the serious complications of tongue prolapse, is here presented. The procedure consists of a the insertion of horseshoe-shaped Kirschner wire, the ends of which are fixed to the posterior mandibular segments, thus acting as a scaffolding for the lacerated soft tissues of the anterior two-thirds of the tongue, floor of the mouth and the submandibular region. This technique provides an acceptable appearance and assists feeding, reduces dribbling and dryness of the tongue, limits the likelihood of infection of the soft tissues of the floor of the mouth with subsequent contracture, affords scaffolding for the soft tissues, foundation for bone grafts, and permits greater freedom in augmenting the vermilion of the lower lip.

Bone Wires↗
PubMed1986

Bone tissue response to irradiation and treatment model of mandibular irradiation injury. An experimental and clinical study.

The present study was conducted on bone tissue responses to irradiation towards a treatment model of mandibular irradiation injury by comparing the results of experimental observations of irradiation effects on rabbit hind legs and rat mandibular bones (paper I, II and III) with clinical observations of irradiation effects on the human mandible (paper IV, V and VI). The main results of the study were as follows: Bone marrow haemorrhage, eosinophilia and incipient edema were encountered in the rabbit leg one day after a single irradiation dose. Edema and fibrosis were the salient features after five weeks, while both regenerative and fibrotic changes predominated eleven weeks after irradiation. The changes were the more extensive the greater the irradiation dose was. Empty lacunae as a sign of cell damage in cortical bone already appeared on the first day after irradiation; this effect reached its maximum when the dose was 20 Gy or more. Bone marrow and subcutaneous tissue pO2 and pCO2 were measured by means of implanted Silastic tonometers in irradiated and nonirradiated rabbit hind legs. Single dose irradiation was followed by a rapid, dose dependent decrease of marrow pO2. The corresponding effect on pCO2 was weaker and appeared later. The response to hyperoxia in the bone marrow became weaker when the irradiation dose increased. Less significant was the response of CO2 tension to hyperoxia. O2 and CO2 tensions were recovered after single dose irradiation both in subcutaneous tissue and in bone marrow, but the reduction was less in bone marrow. During the twelve weeks observation period clearly better recovery in tissue gas tensions was observed in subcutaneous tissue than in bone marrow. Nonirradiated periosteal grafts on irradiated bone cavities in the rabbit tibia induced more rapid and intense mature bone formation than irradiated periosteal grafts. The irradiated periosteum, even after a single dose of 20 Gy, had some osteogenetic capacity. The alkaline phosphatase content was lowered eight weeks after surgery in irradiated legs but clearly exceeded control values twelve weeks after surgery indicating new bone formation. Lysosomal enzyme DAP II contents were increased in all irradiated specimens as a sign of disturbed bone formation. The tissue concentrations of acid phosphatase, cytochrome oxidase, lactate dehydrogenase, isocitrate dehydrogenase, glucose-6-phosphate dehydrogenase and succinate dehydrogenase in the immediate postirradiation period showed a greater increase in activity in the cut lines of the irradiated rat mandibles than in those of the nonirradiated mandibles.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2002

Mechanosensory and thermosensory changes across the border of impaired sensitivity to pinprick after mandibular nerve injury.

PURPOSE: The study goal was to determine how sensory function varies across the border of impaired sensitivity to pinprick in patients with mandibular nerve injuries. PATIENTS AND METHODS: Borders of decreased sensitivity to pinprick were mapped in 15 patients who reported altered sensation. Four mechanoreceptive, 2 thermoreceptive, and 2 thermonociceptive functions were studied at 5 sites separated by 0.6 cm across the border. The tests were repeated to evaluate day-to-day consistency in the pattern of variation for each sensory measure. RESULTS: The estimates of sensory function were not found to vary in a systematic manner from outside to inside the pinprick-impaired area for all patients for any of the 8 tests. However, for every test, some patients exhibited large variations. On average, the magnitudes of loss in contact detection, subjective intensity of light touch, and direction discrimination were greatest; the magnitudes of loss in 2-point perception and in heat and cold pain perception were least. Some patients provided no evidence of impairment on certain tests. For some patients, the estimates suggested increased sensitivity within the pinprick-impaired area (eg, to noxious cold stimuli). CONCLUSIONS: Although certain patients exhibit impairment, there is no obligatory loss in light touch, 2-point perception, direction discrimination, or temperature perception across the border of decreased sensitivity to pinprick. The differences among patients suggest that the data from individual patients should be evaluated in clinical studies and in clinical practice. Researchers should not rely solely on average values and summary statistics.

Adult↗
PubMed2003

Use of orthodontic treatment as an aid to third molar extraction: a method for prevention of mandibular nerve injury and improved periodontal status.

BACKGROUND: Impaction of mandibular third molars predisposes to pathological conditions including periodontal disease. Extraction of these teeth also may lead to damage to the nerve and to periodontal involvement of the second molars. This report describes a series of cases in which the third molars were orthodontically induced to erupt to prevent the sequelae associated with extraction. METHODS: Impacted mandibular third molars in 18 patients were surgically exposed following placement of an orthodontic appliance. Depending on the individual case, 1 of 3 approaches was used: attachment of a bracket, placement of a post in the root canal, or placement of an orthodontic wire through a bucco-lingual canal. After suturing the mucoperiosteal flap, the orthodontic appliance was activated. After the tooth erupted, it was removed and periodontal parameters were measured on the second molar. RESULTS: No damage to the inferior alveolar nerve was found. Probing depths on the second molar were reduced from 7.9 +/- 1.6 mm on the buccal and 7.4 +/- 1.0 mm on the lingual to 1.8 +/- 0.7 mm and 1.9 +/- 0. 7 mm, respectively. There was an average gain of 5.0 mm in attachment. Keratinized tissue increased from 2.9 +/- 0.7 to 3.8 +/- 0.6 mm. CONCLUSIONS: The interdisiplinary use of periodontics and orthodontics results in non-surgical removal of impacted mandibular third molars without damage to the inferior alveolar nerve and iatrogenic periodontal sequelae to the second molars.

Adolescent↗
PubMed2002

Management of patients with trigeminal nerve injuries after mandibular implant placement.

BACKGROUND: Placement of mandibular endosseous implants can result in damage to the lingual nerve, the inferior alveolar nerve or both nerves. All dentists who place mandibular implants should be aware of the appropriate early management of these injuries, as well as the appropriate time to refer patients with these injuries to a microneurosurgeon. OVERVIEW: The lingual nerve is less likely to undergo spontaneous regeneration than is the inferior alveolar nerve, which is protected within the inferior alveolar canal. Since the inferior alveolar canal can be seen on most panoramic radiographs and on all high-quality computed tomographic scans, it is easier to avoid damage to the inferior nerve than to the lingual nerve, which is not visualized on radiographs and whose relationship to the posterior portion of the mandible varies from person to person. RESULTS: The authors reviewed one study that showed that lingual nerve repair helped 90 percent of patients. A second study found that patients who underwent lingual nerve repair reported a mean score of 7 on a scale from 0 to 10 in regard to the postoperative return of nerve function. Several other studies reported favorable patient responses to inferior alveolar nerve repair. CONCLUSIONS AND CLINICAL IMPLICATIONS: These results reinforce the need for early referral and intervention when inferior alveolar nerve injuries occur. Failure to refer patients with trigeminal nerve injury before distal nerve degeneration develops prevents minimization of the injury through microneurosurgical repair.

Dental Implantation, Endosseous↗
PubMed1991

Incidence of inferior alveolar nerve injury in mandibular third molar surgery.

This paper documents the incidence of inferior alveolar nerve injury and resultant sensory disturbance encountered in the removal of 100 consecutive impacted mandibular third molars. Five cases of anesthesia and/or paresthesia resulted and all but one of these resolved within six months. The lack of direct correlation between surgical exposure of the neurovascular bundle intraoperatively and the proximity of radiographic images of tooth root and mandibular canal, with the occurrence of sensory deficit, is noted. Our findings support the 1979 Recommendations of NIHCDCRTM*, upon which the policy of informed consent regarding nerve injury was based.

Adolescent↗
PubMed2002

Risk factors of nerve injury during mandibular sagittal split osteotomy.

There is little objective data about whether surgical technique or mandibular anatomy are a risk for inferior alveolar nerve (IAN) injury during bilateral sagittal split osteotomy (BSSO). Orthodromic sensory nerve action potentials (SNAPs) of the IAN were continuously recorded on both sides in 20 patients with mandibular retrognathia during BSSO operation. Changes in latency, amplitude, and sensory nerve conduction velocity (SNCV) at baseline and at different stages of the operation were analyzed. The SNAP latencies prolonged, the amplitudes diminished, and the SNCVs slowed down during BSSO (P = 0.0000 for all parameters). The most obvious changes occurred during surgical procedures on the medial side of the mandibular ramus. There was a clear tendency towards more disturbed IAN conduction with longer duration of these procedures (right side R = -0.529. P = 0.02; left side R = -0.605, P = 0.006). Exposure or manipulation of the IAN usually had no effect on nerve function, but the IAN conduction tended to be more disturbed in cases with nerve laceration. Low corpus height (R = 0.802, P = 0.001) and the location of the mandibular canal near the inferior border of the mandible (R = 0.52, P = 0.02) may increase the risk of IAN injury. There was no correlation between the age of the patients and the electrophysiological grade of nerve damage.

Action Potentials↗
PubMed2004

[Nerve injury during mandibular third molar surgery. The importance of preoperative diagnosis and surgical skill].

A 26-year-old woman was referred by a dentist to an oral and maxillofacial surgeon after an unsuccessful attempt to remove a mandibular third molar. A panoramic radiograph showed the remaining root of the third molar and the patient suffered from insensitivity of the lower lip. The root of the third molar was removed surgically. The sensitivity of the lip recovered completely within three months. Injury of the inferior alveolar nerve and the lingual nerve is a serious complication after mandibular third molar removal. The inferior alveolar nerve is at risk for injury if the third molar root is intimately connected with the mandibular canal. Refraining from preoperative clinical and radiographic diagnostics is malpraxis. Surgical skill is a prerequisite to reduce the risk of nerve injury.

Adult↗
PubMed1989

[A case of greater auricular nerve autologous nerve grafting for inferior alveolar nerve injury by mandibular fracture].

The results of peripheral nerve repair have been greatly improved in the last few years following the introduction of micro-surgery and increased application of free autologous nerve transplants. In the field of oral surgery, a rich experience has been made in plastic and reconstructive repair. The inferior alveolar nerve is endangered by a series of mandibular fractures, with fracture lines running along the nerve canal. For plastic repair of the inferior alveolar nerve, we interpose an autologous transplant from the greater auricular nerve.

Adult↗
PubMed2004

Recovery of nerve injury after mandibular sagittal split osteotomy. Diagnostic value of clinical and electrophysiologic tests in the follow-up.

The diagnostic value of several clinical, quantitative sensory tests (brush-stroke directional discrimination (BSD), touch detection threshold (TD), warm/cold (W/C) and sharp/blunt discrimination (S/B)), and electrophysiologic tests (mental nerve blink reflex (BR), nerve conduction study (NCS), cold (CDT), and warm (WDT) detection thresholds) in the recovery of inferior alveolar nerve (IAN) injury was evaluated in a prospective 1-year follow-up study of 20 patients after bilateral sagittal split osteotomy (BSSO). The subjective sensory alteration was assessed from patients' drawings. The predictive values of different tests at 2 weeks were determined in relation to the subjective sensory recovery at 12 months. The most pronounced recovery of the nerve damage occurred during the first 3 months according to all measures used. After 3 months, the electrophysiologic tests, especially the NCS, indicated significant further improvement. Except for the TD test, all other clinical test results were normal already at 3 months postoperatively. At early and late controls, the NCS and the thermal quantitative sensory testing could best verify the subjective sensory alteration, and most accurately assess the degree of thick and thin fibre dysfunction. At 1 year, the nerve dysfunction, as revealed by the NCS, corresponded with the figures of sensory alteration reported by the patients (35% R, 40% L). The W/C, BSD, S/B and WDT tests had the best early positive predictive values. Electrophysiologic tests had higher negative predictive values compared to clinical tests.

Adolescent↗
PubMed1982

Repair of complicated mandibular defects.

In most instances, the injured mandible can be successfully repaired with arch bars and intermaxillary fixation. However, it is important to identify certain potential problem situations early and apply special techniques for their treatment. Potential management problems, such as the non-compliant patient, the edentulous patient, gunshot wounds, radiated mandibles, tumors, and osteomyelitis, are reviewed. The use of special techniques, eg, the dynamic compression plate, the Morris biphase apparatus, the cobalt-chromium alloy (Vitallium) basket, a suction-irrigation apparatus, and the mandibular reconstruction plate, are described to show how they may be effectively applied to these special situations. With early recognition of these management problems and proper application of these more sophisticated techniques, the quality of care for patients, with mandibular injuries can be enhanced.

Age Factors↗
PubMed1996

[War injuries of the mandible and sequelae 50 years later].

About 50 years after the end of World War II 84 former soldiers of the German army were examined for aftereffects of their war injuries. Among the data recorded for analysis were the age at which the injury was incurred, the examination intervals, the region affected by the injury and the cause of the injury, but also the different levels of aftereffects of injuries. A total of 53 applicants had suffered mandibular injuries. Considering the wide scattering range, it can be concluded that values of about 20 percent represent a mean degree of incapacitation, primarily due to a combination of loss of teeth and parts of the alveolar process and the effects on the prosthetic support. Casuistic examples illustrate special histories or developments including sarcomagenesis in the region originally affected by the injury.

Aged↗
PubMed1985

Inter-rami intraoral fixation of severely comminuted mandibular war injuries.

A new technique is presented for the reduction, stabilization and immobilization of an avulsed maxilla and severe comminuted body and symphysis injuries of the mandible sustained by Iraqi soldiers in combat. The technique consists of the use of intraoral inter-rami horseshoeshaped Kirschner wire as a scaffolding for multiple circumferential wires tied around bone fragments. The technique is simple, short, effective and allows function of the lower jaw.

Bone Wires↗
PubMed1963

BONE GRAFTING.

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Bone Transplantation↗