Trigeminal nerve injuries related to restorative treatment

Faculty Dental Journal, 2011

The most significant complications from dental surgical interventions are iatrogenic trigeminal nerve injuries, which can result in permanent altered sensation and pain, causing considerable functional and psychological disability. This paper provides some useful tips on minimising the risks of these injuries. By understanding the risk factors and modifying the resulting intervention, more of these injuries may be prevented.

BDJ, 2013

is no reparative treatment available, thus avoidance is preferable. TNIs caused by local anaesthesia block injections have an estimated injury incidence of between 1:26,762 to 1/800,000. 2 Reports of incidences include 1:588,000 for prilocaine and 1/440,000 for articaine inferior alveolar nerve (IAN) blocks, both of which are 20 times greater than for Lidocaine injections. The nerve that is usually damaged during IAN block injections is the lingual nerve (LN), accounting for 70% of nerve injuries. Recovery is reported to take place within eight weeks for 85-94% of cases 6 meaning that for about 10% of patients, injuries will be permanent. Large population surveys need to be carried out in order to determine the true incidence. Nerve injury due to LA is multi-factorial, with physical (needle, compression due to epineural or perineural haemorrhage) or

Journal of Maxillofacial and Oral Surgery, 2018

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.

British Dental Journal, 2002

Objective To investigate the relationships between eruption status, gender, social class, grade of operator, anaesthetic modality and nerve damage during third molar surgery. Design Two centre prospective longitudinal study. Setting The department of oral and maxillofacial surgery, University Hospital Birmingham NHS Trust and oral surgery outpatient clinics at Birmingham Dental Hospital. Subjects A total of 391 patients had surgical removal of lower third molars. Sensory disturbance was recorded at one week post operatively. Patients with altered sensation were followed up at one month, three months and six months following surgery. Results 614 lower third molars in 391 patients were removed. Fortysix procedures (7.5%) were associated with altered sensation at one week with three procedures (0.49%) showing persistent symptoms at six months. Of these 46 nerve injuries, 26 (4.23%) involved the lingual nerve and 20 (3.25%) the inferior dental nerve (IDN). All three persistent sensations were IDN related. A logistic regression model found that the use of a lingual retractor χ 2 =11.559, p=0.003 was more significant than eruption status χ 2 =12.935, p=0.007. There was no significant relationship between anaesthetic modality, age, social class, sex and seniority of operator. Conclusions There was no link between the choices of local or general anaesthesia and nerve damage during lower third molar removal when difficulty of surgery was taken into account.

British Dental Journal, 2010

Few studies describe the range of signs, symptoms and functional deficits that result from iatrogenic injury to the inferior alveolar and lingual nerves. The aims of the present study were: To assess the signs, symptoms and • functional problems experienced by patients suffering from non-surgical iatrogenic damage to the inferior alveolar or lingual nerves To identify risk factors associated • with these injuries.

International journal of oral and maxillofacial surgery, 2012

Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. This study reports the signs and symptoms that are the features of trigeminal nerve injuries caused by mandibular third molar (M3M) surgery. 120 patients with nerve injury following M3M surgery were assessed. All data were analysed using the SPSS statistical programme and Microsoft Excel. 53 (44.2%) inferior alveolar nerve (IAN) injury cases and 67 (55.8%) lingual nerve injury (LNI) cases were caused by third molar surgery (TMS). Neuropathy was demonstrable in all patients with varying degrees of paraesthesia, dysaesthesia (in the form of burning pain), allodynia and hyperalgesia. Pain was one of the presenting signs and symptoms in 70% of all cases. Significantly more females had IAN injuries and LNIs (p<0.05). The mean ages of the two groups of patients were similar. Speech and eating were significantly more problematic for patients with LNIs. In concl...

Oral and Maxillofacial Surgery Clinics of North America, 2007

2012

Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. This study reports the signs and symptoms that are the features of trigeminal nerve injuries caused by mandibular third molar (M3M) surgery. 120 patients with nerve injury following M3M surgery were assessed. All data were analysed using the SPSS statistical programme and Microsoft Excel. 53 (44.2%) inferior alveolar nerve (IAN) injury cases and 67 (55.8%) lingual nerve injury (LNI) cases were caused by third molar surgery (TMS). Neuropathy was demonstrable in all patients with varying degrees of paraesthesia, dysaesthesia (in the form of burning pain), allodynia and hyperalgesia. Pain was one of the presenting signs and symptoms in 70% of all cases. Significantly more females had IAN injuries and LNIs (p<0.05). The mean ages of the two groups of patients were similar. Speech and eating were significantly more problematic for patients with LNIs. In conclusion, chronic pain is often a symptom after TMS-related nerve injury, resulting in significant functional problems. Better dissemination of good practice in TMS will significantly minimize these complex nerve injuries and prevent unnecessary suffering.Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Journal of Maxillofacial and Oral Surgery, 2015

Objective To report the incidence of trigeminal neuropathy seen among new patients in a referral center within a period of 1 year (2013). The cause of damage, method of management and treatment outcome was assessed after 1-year follow-up. Materials and Methods The records of all new patients visiting the oral and maxillofacial unit of the University hospital of Leuven in 2013 were screened for a history of damage to branches of the trigeminal nerve. The selected records were examined and the duration of nerve damage, received treatment as well as the outcome of the neuropathy after treatment was noted after 1-year follow-up. Results 56 patients (21 males, 35 females) from 7602 new patients had symptoms of damage to the trigeminal nerve branch. These symptoms persist in more than onethird of the patients [21/56 (37.5 %)] after 1-year followup. The least recovery is seen from oral surgery, implant placement, orthognathic surgery and tooth extraction. After 1 year 85 % (12/14) of neuropathic pain cases still have their symptoms as compared to 19 % (5/26) of patients with hypoesthesia. Conclusion This study shows a low incidence of nerve damage among the new patients presenting in oral and maxillofacial surgery clinic (\1 %); however, one-third of patients who sustain nerve damage never recover fully. Early diagnosis of the cause of neuropathy is essential. There is a need to objectively assess all patients with symptoms of trigeminal nerve damage before, during and after treatment.

Journal (Canadian Dental Association)

Prolonged and possibly permanent change in sensation due to nerve damage can occur after dental injections. Although the condition is rare, many practitioners will see this form of nerve injury during their careers. The exact mechanism of the injury has yet to be determined, and little can be done to prevent its occurrence. This type of injury carries with it many functional and psychological implications, and referral to both dental and medical specialists may be necessary for continued follow-up and possible treatment.