Responsabilidade profissional por lesão do nervo lingual durante exodontia de terceiro molar inferior: análise de nove processos judiciais / Professional responsibility for lingual nerve injury during lower third molar extraction: analysis of nine court proceedings

Introdução: A remoção cirúrgica dos terceiros molares inferiores apresenta o risco potencial de lesões a estruturas nobres como o nervo lingual devido sua localização anatômica. O grau de comprometimento do nervo indicará se a lesão é transitória ou permanente. A injúria nervosa pode motivar o paciente a acionar judicialmente o cirurgião-dentista, e sendo evidenciada a culpa profissional, caberá a reparação pecuniária dos danos causados ao paciente, sejam de natureza material ou moral. Objetivo: Analisar nove decisões judiciais de 1ª e 2ª instância, disponíveis no site do Tribunal de Justiça de São Paulo (TJSP), motivadas pela lesão do nervo lingual durante a exodontia de terceiro molar inferior. Metodologia: Após a leitura e análise foram extraídas informações como: perfil das partes, tempo de duração dos processos, procedência ou não da ação, valor da indenização, responsabilidade profissional e presença de TCLE. Resultados: Na primeira instância, seis dos nove casos foram julgados improcedentes; em segunda instância, quatro destas sentenças foram reformadas para procedência. No total, após decisão de segunda instância, houve procedência da ação em sete dos nove casos. Nas ações procedentes, as indenizações para dano moral variaram de R$ 5 mil a R$ 50 mil, sendo a imperícia e negligência as modalidades de culpa mais atribuídas aos profissionais. Conclusão: Sabendo-se que a lesão do nervo lingual durante a extração de terceiro molar inferior, mesmo previsível, nem sempre é evitável, verifica-se a importância do TCLE (ou documento similar) na prática clínica como instrumento de defesa jurídica do profissional, diante da alegação de falha de informação. Este documento foi mencionado em apenas três dos nove casos processuais, sendo em que em dois destes não houve constatação de falha técnica ou de informação (ação improcedente nas duas instâncias)

Introduction: Surgical removal of lower third molars presents the potential risk of injury to noble structures such as the lingual nerve due to its anatomical location. The level of nerve involvement will indicate whether the injury is transient or permanent. Nervous injury can motivate the patient to sue the dentist, and if professional guilt is evidenced, it will be up to pecuniary compensation for the damage caused to the patient, whether of a material or moral nature. Objective: To analyze nine court decisions of 1st and 2nd instances, available on the Court of Justice of State of São Paulo (Brazil) website, motivated by lingual nerve injury during lower third molar extraction. Methodology: After reading and analysis, information was extracted such as: profile of the litigating parties, duration of the processes, judge decision for the action, indemnity value, professional responsibility and presence of TCLE. Results: In the first instance, six of the nine cases were dismissed, the sentence was reformed in four cases, confirming the merits of the action in seven of the nine cases. In the cases of valid actions, compensation for moral damages ranged from R$ 5 thousand to R$ 50 thousand, with malpractice and negligence being the types of fault most attributed to professionals. Conclusion: Knowing that lingual nerve injury during mandibular third molar extraction, even if predictable, is not always avoidable, the importance of the informed consent (or similar document) in clinical practice as an instrument for the professional's legal defense is mandatory, to avoid the allegation of miss information. This document was mentioned in only three of the nine cases, and in two of these there was no finding of technical or information failure (unfounded action in both instances)

Reconstrucción microquirúrgica del nervio lingual / Microsurgical lingual nerve repair

Resumen Introducción: El daño del nervio lingual posterior a un evento traumático es frecuente durante algunos procedimientos en cirugía maxilofacial. Siendo la desinclusión de terceros molares la causa más frecuente. La reconstrucción microquirúrgica del nervio es una técnica eficaz con éxito sobre el 80% de los casos. Objetivo: El objetivo de este artículo es presentar dos casos de reconstrucción microquirúrgica del nervio lingual. Casos Clínicos: Pacientes de sexo femenino tratadas por el equipo de Cirugía Maxilofacial del Hospital Dr. Abraham Godoy Peña. Donde se les realiza la reconstrucción microquirúrgica del nervio lingual, ambas presentan resultados positivos al año y medio, con una recuperación funcional sensorial (FSR +) y sensorial positiva S3 y S4+ respectivamente para cada paciente. Discusión: El momento de la reconstrucción microquirúrgica del nervio lingual no está bien definido. Sin embargo, la mayoría de los autores sugieren un tratamiento quirúrgico temprano, antes de los 6 meses. El daño del nervio lingual a menudo afecta la calidad de vida del paciente. La reconstrucción microquirúrgica del nervio lingual debe ser incorporada dentro del algoritmo de tratamiento del daño del nervio lingual.

Introduction: Lingual nerve injury after a traumatic event is frequent during some maxillofacial procedures, being the third molar extraction the most frequent cause. Lingual nerve injury may be performed in different grades of damage and it is often invalidating. Microsurgical reconstruction is an efficacy technique with a rate of success over 80%. Aim: To present two cases of lingual nerve microsurgical reconstruction after lingual nerve injury. Clinical Cases: Two female patients suffered lingual nerve injury after third molar extraction, both were submitted to lingual nerve reconstruction. It was performed the microsurgery reconstruction of the lingual nerve, both present favorable outcomes follow up to 1.5 years, including positive Functional sensory recovery (FSR +) and sensorial test S3 and S4+ respectively for each patient. Discussion: The timing of lingual nerve microsurgery is not well defined; however, most authors suggest an early surgical treatment before 6 months. The lingual nerve injury often affect the quality of life of the patient. Microsurgery reconstruction should be incorporated into the treatment algorithm of lingual nerve injury.

Trigeminal nerve injuries. Four years' experience at a single Argentine referral center and a literature review / Lesiones del nervio trigémino. Cuatro años de experiencia de un servicio quirúrgico odontológico en Argentina y revisión bibliográfica

ABSTRACT The aim of this retrospective study was to describe the etiology and characteristics of trigeminal nerve injuries referred to a specialized center in Buenos Aires, Argentina. A retrospective analysis was performed of patients referred from February 2016 to January 2020. Age, sex, intervention performed, nerve affected, time elapsed from injury, diagnosis, location, and whether patient had signed informed consent were recorded. A descriptive analysis of the data was made, and 95% confidence intervals were calculated for prevalence. The study sample consisted of 30 subjects (31 nerve injuries), 19 female and 11 male, average age (±SD) 40 ± 17 years. The inferior alveolar nerve was the most frequently injured nerve (74%,) while the lingual nerve accounted for 26%. The most common etiologies were inferior molar extractions (47%), dental implants (20%), and local anesthesia (13%). Other etiologies were autologous mandibular bone grafts for dental implants, removal of cysts associated with the inferior third molar, and endodontic treatment. Dental Institutions at which treatment was provided were found to be significantly associated with patients being warned and asked to sign informed consent (p<0.05), while dentists working at private offices requested fewer consents. The most frequent symptom was paresthesia, and 5 patients suffered spontaneous or evoked pain. Only 2 patients intended to file legal claims. Dentists should be aware of the debilitating effects resulting from trigeminal injuries, the complexity of their resolution and the importance of carefully planning dental procedures to prevent them.

RESUMEN El objetivo de este estudio fue describir la etiología y características de las lesiones del nervio trigémino remitidas a un servicio de referencia especializado en Buenos Aires, Argentina. Se realizó un análisis retrospectivo de los pacientes remitidos desde febrero de 2016 a enero de 2020. Se registraron edad, género, intervención recibida, nervio afectado, tiempo transcurrido desde la lesión, diagnóstico, ubicación y firma del consentimiento informado previo a la intervención Se realizó un análisis descriptivo de los datos y se calcularon intervalos de confianza del 95%. La muestra del estudio consistió en 30 sujetos (31 lesiones nerviosas), 19 mujeres y 11 hombres, con una edad promedio (± DE) de 40 ± 17 años. Aproximadamente 3 de cada 4 lesiones correspondieron al nervio alveolar inferior, representando el resto al nervio lingual. Las etiologías más frecuentes fueron la extracción dentaria (47%), los implantes dentales (20%) y la aplicación anestesia local (13%). Otras etiologías fueron la regeneración ósea para la colocación de implantes mandibulares, la extirpación de quistes asociados al tercer molar inferior y el tratamiento endodóntico. Se encontró que el tipo de establecimiento donde se realizó el procedimiento odontológico que generó la lesión, se asoció significativamente con los pacientes a los que se les advirtió y se les pidió que firmen el consentimiento informado (p<0.05); los odontólogos que trabajan en consultorios privados obtienen una menor proporción de consentimientos que los de las instituciones. El síntoma más frecuente fue la parestesia y 5 pacientes sufrieron dolor espontáneo o evocado. Solo 2 pacientes tenían intención de iniciar acciones legales. Teniendo en cuenta que son lesiones potencialmente permanentes, y de resolución compleja, la comunidad odontológica debe realizar especiales esfuerzos para disminuir esta complicación.

Alternativas Microquirúrgicas (Autoinjertos Nerviosos / Aloinjertos Nerviosos / Conductos Nerviosos) para la Recuperación Sensitiva Funcional de Nervio Alveolar Inferior y Nervio Lingual: Revisión de la Literatura / Microsurgical Alternatives (Nerve Autografts / Nerve Allografts/ Nerve Ducts) for Functional Sensory Recovery of the Lower Alveolar Nerve and Lingual Nerve: Review of the Literature

RESUMEN: Objetivo: analizar y comparar las modalidades actuales de reconstrucción microquirúrgica (autoinjertos, aloinjertos y conductos nerviosos) para lograr recuperación sensitiva funcional (RSF) en reparaciones de nervio alveolar inferior (NAI) y nervio lingual (NL). Materiales y Métodos: se realizó una revisión de la literatura para identificar estudios relacionados con reconstrucciones de NAI y NL. Los estudios incluidos proporcionaron un tamaño de muestra definido, modalidad de reconstrucción microquirúrgica y tasas de RSF. Se realizó un test de proporciones para saber si existían diferencias estadísticamente significativas (P <0,05) entre las modalidades de reconstrucción mencionadas. Resultados: se seleccionaron y analizaron 9 estudios que dieron como resultado una muestra de 130 reconstrucciones de NAI y 102 de NL. Entre las reconstrucciones de NAI, se encontró que los autoinjertos y aloinjertos eran superiores para lograr una RSF sobre los conductos nerviosos (P de 0,033 y 0,0397 respectivamente). Entre las reconstrucciones de NL, no se encontraron diferencias estadísticamente significativas. Y al comparar reconstrucciones mediante autoinjertos con aloinjertos, no hubo diferencias estadísticamente significativas para NAI y NL. Conclusiones: Las reconstrucciones mediante aloinjertos y autoinjertos tiene tasas de RSF equivalentes y mejores que los conductos nerviosos. Además, con el uso de aloinjertos, se evitan comorbilidades asociadas al sitio donante.

ABSTRACT: Objective: to analyze and compare the current modalities of microsurgical reconstruction (autografts, allografts, and nerve ducts) to achieve functional sensory recovery (RSF) in repairs of the inferior alveolar nerve (NAI) and lingual nerve (NL). Materials and Methods: a literature review was performed to identify studies related to NAI and NL reconstructions. The studies included provided a defined sample size, microsurgical reconstruction modality, and RSF rates. A test of proportions was performed to find out if there were statistically significant differences (P <0.05) between the mentioned reconstruction modalities. Results: 9 studies were selected and analyzed that resulted in a sample of 130 reconstructions of NAI and 102 of NL. Among the NAI reconstructions, autografts and allografts were found to be better in achieving an RSF than the nerve ducts (P of 0.033 and 0.0397 respectively). Among the NL reconstructions, no statistically significant differences were found. And when comparing reconstructions using autografts with allografts, there were no statistically significant differences for NAI and NL. Conclusions: Reconstructions using allografts and autografts have equivalent and better RSF rates than nerve conduits. Furthermore, with the use of allografts, comorbidities associated with the donor site are avoided.

Incidence of neurosensory deficits following surgical removal of mandibular third molars: a prospective clinical study

Background: The aim of this prospective study was to determine the incidences of inferior alveolar nerve and lingual nerve deficit following surgical removal of impacted mandibular third molars and to evaluate the risk factors responsible for these postoperative neurosensory deficits.Methods: A total of 80 patients who reported to department of oral and maxillofacial surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India requiring surgical removal of impacted mandibular third molar were included in this cross-sectional study. Standard surgical procedure was performed. All patients were reassessed one week post-surgery. Subjectively reported altered sensations were recorded and objective assessments were performed with light touch test, two-point discrimination threshold and pin-pick pain threshold. The collected data was analyzed using the chi square test to find out any clinical relevance.Results: There was no inferior alveolar nerve related neurosensory deficits and 6 (7.5%) resulted in lingual nerve related neurosensory deficits. The incidence of LN deficit for mesioangular, horizontal, distoangular was 1.3%, 3.8% and 2.5% respectively. Type of impaction assumed a mild statistical significance (p = 0.050).Conclusions: This study highlights the importance of careful preoperative clinical and radiographic assessment of patients where third molar surgery is planned. The surgical technique of third molar removal is also likely to have great impact on the outcome.

Management and prevention of third molar surgery-related trigeminal nerve injury: time for a rethink

Trigeminal nerve injury as a consequence of lower third molar surgery is a notorious complication and may affect the patient in long term. Inferior alveolar nerve (IAN) and lingual nerve (LN) injury result in different degree of neurosensory deficit and also other neurological symptoms. The long term effects may include persistent sensory loss, chronic pain and depression. It is crucial to understand the pathophysiology of the nerve injury from lower third molar surgery. Surgery remains the most promising treatment in moderate-to-severe nerve injuries. There are limitations in the current treatment methods and full recovery is not commonly achievable. It is better to prevent nerve injury than to treat with unpredictable results. Coronectomy has been proved to be effective in reducing IAN injury and carries minimal long-term morbidity. New technologies, like the roles of erythropoietin and stem cell therapy, are being investigated for neuroprotection and neural regeneration. Breakthroughs in basic and translational research are required to improve the clinical outcomes of the current treatment modalities of third molar surgery-related nerve injury.

An anatomical study of the lingual nerve in the lower third molar area / 대한해부학회지

The lingual nerve (LN) is a branch of the mandibular division of the trigeminal nerve, and its injury is one of the major complications during oral surgery. This study aims to investigate the anatomy of the LN in the lower third molar area. Twenty sides from ten fresh-frozen adult cadaveric Caucasian heads were examined to measure the diameter of the LN. The mean diameter of the LN was 2.20±0.37 mm (range, 1.61–2.95 mm). There were no statistically significant differences in the measurements between sexes, sides, or tooth status (dentulous or edentulous). Understanding the anatomical features of the LN is essential for performing any surgical procedure in the oral region.

Prevalencia y factores asociados a las lesiones en los nervios alveolar inferior y lingual después de la exodoncia de terceros molares inferiores: Estudio retrospectivo / Prevalence and associated factors of inferior alveolar and lingual nerves injuries after lower third molars extractions: Retrospective study / Prevalência e fatores associados às lesões nos nervos alveolar inferior e lingual após a exodontia de terceiros molares inferiores: Estudo retrospectivo

Dentro de los tratamientos realizados en cirugía oral, la extracción de los terceros molares es la más frecuente y puede ocasionar lesiones nerviosas. Objetivo: Determinar la prevalencia y los factores asociados a las lesiones en los nervios alveolar inferior y lingual después de la extracción de terceros molares inferiores. Materiales y métodos: la muestra fue de 609 prontuarios analizados durante los años 2011-2016 en el Hospital Carlos Andrade Marín de la ciudad de Quito, Ecuador. Fueron consideradas como variables: sexo, edad, posición y profundidad del tercer molar (Pell y Gregory), la inclinación (Winter) y la relación radiográfica con el canal mandibular (Rood y Shehab). Los datos obtenidos fueron pro-cesados utilizando la prueba estadística de Chi-cuadrado con un nivel de significancia de 5%. Resultados: Presentaron lesiones nerviosas el 2,46% de los pacientes atendidos, correspondiendo al 1,64% y 0,82% a los nervios alveolar inferior y lingual respectivamente. La lesión del nervio alveolar inferior está asociado al sexo femenino (p= 0.032) y con la clase III (p= 0.010), mientras que las lesiones del nervio lingual estaban asociadas a la clase I (p= 0.004) y tipo A (p= 0.001). Radio-gráficamente la lesión del nervio alveolar está asociada en el 46,67% con la interrupción de la línea del canal mandibular (p= 0.010). Conclusión: La prevalencia de las lesiones en los nervios alveolar inferior y lingual posterior a la exodoncia del tercer molar inferior en pacientes ecuatorianos es baja, cuidados preoperatorios son importantes para evitar complicaciones postquirúrgicas.

Among the treatments performed in oral surgery, the third molars extraction is the most frequent and may cause nerve in-juries. Objective: To determine the prevalence and associated factors of inferior alveolar and lingual nerves injuries after inferior third molars extractions. Materials and methods: the sample was composed by of 609 records attended during the years 2011-2016 in the Carlos Andrade Marín Hospital in the city of Quito, Ecuador. The following variables were as-sessed: sex, age, position and depth of the third molar (Pell & Gregory), inclination (Winter) and radiographic relationship with the mandibular canal (Rood & Shehab). Data obtained were processed througth the Chi-square test with a significance level of 5%. Results: of all patients attended, 2.46% presented nerves injuries, corresponding to 1.64% and 0.82% to the inferior alveolar and lingual nerves respectively. The inferior alveolar nerve injury is associated with the female sex (p = 0.032) and with the class III (p = 0.010), while the lingual nerve lesions were associated with class I (p = 0.004) and type A (p = 0.001). Radiographically, the alveolar nerve injury is associated in 46.67% with the interruption of the mandibular canal line (p = 0.010). Conclusion: The prevalence of injuries in the inferior alveolar and lingual nerves after lower third molar extractions in Ecuadorian patients is low; preoperative care is important to avoid postoperative complications.

Dentre os tratamentos realizados na cirurgia bucal, a extração dos terceiros molares é a mais frequente e pode causar lesões nervosas. Objetivo: Determinar a prevalência e os fatores associados às lesões nos nervos alveolar inferior e lingual após a extração de terceiros molares inferiores. Materiais e métodos: a amostra foi de 609 prontuários analisados durante os anos de 2011 a 2016 no Hospital Carlos Andrade Marín, na cidade de Quito, Equador. Foram consideradas as seguintes variáveis: sexo, idade, posição e profundidade do terceiro molar (Pell e Gregory), inclinação (Winter) e relação radiográfica com o canal mandibular (Rood e Shehab). Os dados obtidos foram processados pelo teste estatístico Qui-quadrado com nível de significância de 5%. Resultados: Apresentaram lesões nervosas 2,46% dos pacientes atendidos, correspondendo a 1,64% e 0,82% dos nervos alveolar inferior e lingual respectivamente. A lesão do nervo alveolar inferior está associada ao sexo feminino (p = 0.032) e à classe III (p = 0.010), enquanto as lesões do nervo lingual foram associadas à classe I (p = 0.004) e tipo A (p = 0.001). Radiograficamente, a lesão do nervo alveolar está associada em 46,67% com a interrupção da linha do canal mandibular (p = 0.010). Conclusão: A prevalência de lesões nos nervos alveolar inferior e lingual após a extração do terceiro molar inferior em pacientes equatorianos é baixa; cuidados pré-operatórios são importantes para evitar complicações pós-operatórias.

Desórdenes neurosensoriales posextracción de terceros molares inferiores retenidos / Neurosensory disorders after removal of retained lower third molars

Introducción: Los desórdenes neurosensoriales aparecen vinculados a la exéresis de terceros molares inferiores; su mal diagnóstico y tratamiento acarrean una larga permanencia de los mismos. Objetivo: Caracterizar desde el punto de vista clínico y terapéutico los desórdenes neurosensoriales asociados a la extracción quirúrgica de terceros molares inferiores retenidos. Material y Método: Se realizó un estudio cuasi-experimental en 136 pacientes sometidos a exéresis quirúrgica de terceros molares inferiores retenidos con criterios específicos de inclusión en la Facultad de Estomatología de La Habana, período 2016-2017. Los pacientes fueron intervenidos y examinados a los 3 y 10 días tras la intervención para identificar desórdenes neurosensoriales. Se emplearon 3 test diagnósticos para definir el nivel de función neurológica; se utilizó escala VAS para evaluar el nivel de sensibilidad del paciente, y el interrogatorio estandarizado para categorizar los tipos de desórdenes sensoriales. Se registraron las variables: edad, sexo, clase de retención, modificación de técnica quirúrgica y hallazgos neurosensoriales. Resultados: Presentó desórdenes neurosensoriales 3,5 por ciento de los pacientes; 2,1 por ciento del sexo femenino. La clase III, posición C, mesioangular fue la retención más vinculada con 2,1 por ciento. El nervio dentario inferior fue el más involucrado (2,1 por ciento) y la parestesia fue el hallazgo más frecuente (60 por ciento). El 60 por ciento de los desórdenes involucionaron a los 180 días. Conclusiones: Los desórdenes neurosensoriales vinculados a la exéresis de terceros molares inferiores registran una baja frecuencia en la población estudiada, predomina en el nervio dentario inferior, en retenciones clase III, posición B, mesioangular y se asocia más a técnicas con ostectomías y odontosecciones. La disestesia es la entidad más refractaria al tratamiento(AU)

Introduction: Neurosensory disorders are linked to the removal of retained lower third molars; its misdiagnosis and poor treatment can lead to their long persistence. Objective: To characterize neurosensory disorders associated with the removal of retained lower third molars from the clinical and therapeutic point of view. Material and Method: A quasi-experimental study was conducted in 136 patients with specific inclusion criteria who underwent surgical removal of retained lower third molars in the Dental Faculty of the University of Havana, between 2016-2017. The patients were operated on and examined 3 and 10 days after surgery to identify the presence of neurosensory disorders. Three types of diagnostic tests were used to define the level of neurological function. VAS Scale was used to evaluate the sensitivity level in the patient, and the standardized interview was made to categorize the type of neurosensory disorders. Variables such as age, sex, kind of retention, modification of surgical techniques, and neurosensory findings were recorded. Results: 3,5 percent of patients had neurosensory disorders, 2,1 percent were female. Class III, position C, mesioangular was the most linked retention (2,1 percent). The inferior dental nerve was the most involved (2,1 percent), and paresthesia was the most frequent finding (60 percent). The 60 percent of disorders recovered their normal function after 180 days. Conclusions: The appearance of neurosensory disorders linked to the removal of lower third molars presented a low frequency in the population studied, predominating in the inferior dental nerve, in class III retentions, Position B, mesioangular position; and they are more linked to the surgical techniques of ostectomies and odontosections. Dysesthesia is the most refractory to treatment(AU)

A Rare Case Of Accessory Nerve To Mylohyoid Communucating With Lingual Nerve And Its Clinical Implications

Nerve to mylohyoid is a branch of inferior alveolar nerve given just before it enters the mandibular foramen. Itcourses inferior to the origin of mylohyoid and supplies both mylohyoid and anterior belly of digastric along itssuperficial surface. An accessory branch from inferior alveolar nerve was discovered during routine dissection.The nerve was found only on the left side. Additionally, a communicating branch was seen between lingual nerveand accesoory nerve to mylohyoid. Knowledge of the variations of the mandibular nerve, its branches andcommunications are clinically important especially for attaining adequate local anaesthesia during routineoral and dental procedures.

Dexamethasone treatment for bilateral lingual nerve injury following orotracheal intubation

Lingual nerve injury is a rare complication of general anesthesia. The causes of lingual nerve injury following general anesthesia are multifactorial; possible mechanisms may include difficult laryngoscopy, prolonged anterior mandibular displacement, improper placement of the oropharyngeal airway, macroglossia and tongue compression. In this report, we have described a case of bilateral lingual nerve injury that was associated with orotracheal intubation for open reduction and internal fixation of the left distal radius fracture in a 61-year-old woman. In this case, early treatment with dexamethasone effectively aided the recovery of the injured lingual nerve.

A typical Communicating Pattern between Branches of Mandibular Nerve: Clinical Significance & Review.

The posterior division of the mandibular nerve is known to have three branches in the infra temporal fossa namely lingual, inferior alveolar and auriculotemporal nerves. These branches mainly innervate oral and temporomandibular structures like tongue, lower gingiva, mandibular bone, teeth, and part of the lower lip, chin and salivary glands. We describe a case with unusual communications between these branches. The knowledge of any unusual communications among these branches is highly significant due to the various treatment procedures undertaken in the region.

Avaliação de nova técnica para anestesia do nervo lingual / Evaluation of a new technique for anaesthesia of lingual nerve

Frequentemente os cirurgiões dentistas se veem diante de situações em que há necessidade de anestesiar a língua ou a mucosa lingual, as quais são inervadas sensitivamente pelo nervo lingual, ramo do trigêmeo. Para isso os mesmos utilizam de técnicas para anestesia do nervo alveolar inferior, que concomitantemente são também utilizadas para anestesia do nervo lingual. Este trabalho teve como objetivo avaliar uma nova técnica para anestesia específica do nervo lingual, na qual a dessensibilizacão do nervo alveolar inferior não é realizada. Foram selecionados 32 pacientes voluntários, sendo 16 pacientes do sexo masculino e 16 do sexo feminino, com idade entre 20 e 40 anos, que compareceram ao Pronto Socorro Odontológico da Universidade Federal de Uberlândia, com urgência de tratamento, no qual o nervo lingual seria anestesiado. O trabalho foi realizado em uma etapa, que consistia no emprego da técnica proposta para anestesia do nervo lingual em sessão única. A avaliação da eficácia da técnica foi realizada através da sensibilidade dolorosa. Os resultados foram submetidos aos testes teste T de student e o teste de Wilcoxon, havendo diferença estatística (p<0,05), quando comparados os intervalos de tempo (1', 2', 3', 4', 5'), numa mesma região, ápice (A), dorso (D) e raiz (R). Em relação ao sexo e antímero, não se observou diferença estatisticamente significante. Concluise que a técnica anestésica proposta para anestesia do nervo lingual foi eficaz, possuindo menor tempo de latência e necessitando de menor quantidade de solução anestésica, o que contribui para o tratamento de pacientes com desordens sistêmicas.

Often dentists find themselves in situations where there is need anesthetize the tongue or the tongue mucosa, which are sensitively innervated by the lingual nerve, a branch of the trigeminal nerve. For this use the same techniques for anesthesia of the inferior alveolar nerve, which are also simultaneously used for anesthesia of the lingual nerve. This work aimed to evaluate a new technique for specific anesthesia of the lingual nerve, in which the desensitization of the inferior alveolar nerve is not performed. We selected 32 volunteer patients, 16 males and 16 females, aged between 20 and 40, who attended the Emergency Dental (PSO) of the Federal University of Uberlandia, with emergency treatment, in which the nerve lingual be anesthetized. The work was performed in one step, which consisted in the use of proposed technique for anesthesia of the lingual nerve in one session. Assessing the effectiveness of the technique was performed through the soreness. The results were tested by Student t test and the Wilcoxon test, a statistical difference (p <0.05) when comparing the time intervals (1 ', 2', 3 ',4', 5 '), a same region, the apex (A), dorsal (D) and root (R). In relation to sex and antimere, there was no statistically significant difference. It is concluded that the proposed anesthetic technique for anesthesia of the lingual nerve was effective, with lower latency and requiring less amount of anesthetic solution, which contributes to the treatment of patients with systemic disorders.

Lower third molar region / Región del tercer molar inferior

The lower third molar region is an important region for the odontostomatological practice, since it presents a great amount of pathological processes related to the development and eruption of the third molar; thus having a considerable number of surgical interventions. Despite its importance, this region is not accounted for in anatomical terminology nor is it described in topographic anatomy; and in spite of the great number of studies that analyze the surgical anatomy of the region, it is necessary to systematize the description of its boundaries, planes, content, risk elements, anatomical repairs, etc.; therefore, the purpose of the present article is to review the modern concepts related to the surgical anatomy of the lower third molar region and to establish a description based on these concepts...

La región del tercer molar inferior es una región importante para la práctica odontoestomatológica, en ella se presenta una gran cantidad de procesos patológicos relacionados con el desarrollo y erupción del tercer molar, por lo que se practican un gran número de intervenciones quirúrgicas. No obstante su importancia, esta región no se encuentra considerada en la terminología anatómica ni descrita en la anatomía topográfica y a pesar de la gran cantidad de estudios que analizan la anatomía quirúrgica de la región, es necesario sistematizar la descripción de sus límites, planos, contenidos, elementos de riesgo, puntos de reparo, etc., es por ello que el propósito de este artículo es revisar los conceptos modernos relacionados con la anatomía quirúrgica de la región del tercer molar inferior y proponer una descripción basada en estos conceptos...

A Case of Schwannoma of the Mouth Floor Mistaken as a Ranula / 대한이비인후과학회지

Schwannoma is a relatively slow-growing, encapsulated benign tumor that is derived from the Schwann cell of the nerve sheath. We report here on a case of schwannoma of the mouth floor with a review of the literature. A 67-year-old woman presented with a right mouth floor mass, which was first detected 5 years ago. The preoperative diagnosis was ranula on the basis of the physical findings and the computerized tomographic findings. However, the mass was found to be a true neoplastic lesion rather than a cystic lesion in the course of surgical dissection. The permanent pathologic report of the mass was schwannoma. Postoperatively, although the patient had no problem with taste, the pain-sense, speech and swallowing, she had mild deviation of the tongue towards the same side of the mass, which means that the function of the hypoglossal nerve was somewhat impaired. Her tongue deviation was spontaneously resolved within 6 weeks postoperatively.

Injury of submandibular gland and lingual nerve as complication third molar tooth extraction in mandible : a case report

The extraction of an impacted third molar tooth is associated with many complications during the procedure and postoperative care. These complications include bleeding, swelling, pain, infection, as well as root fracture, proximal tooth injury, alveolar bone fracture, lingual nerve and inferior alveolar nerve injury etc. With the exception of a fractured root dislocation in the submandibular space, no direct submandibular gland injury related to extraction surgery has been reported until now. A 40 year old man visited the department of oromaxillofacial surgery at Yeouido St. Mary's Hospital for an extraction of the right mandible third molar. A partial third molar impaction was diagnosed by a clinical and radiographic examination. A surgical tooth extraction was practiced including buccal cortical bone osteotomy. During socket curettage, an encapsulated cyst-like lesion and a verified 3x3 cm neoplasm in the apically lingual direction were found during process of dissection. A biopsy confirmed that the neoplasm involved the submandibular gland and nerve trunk. This unusual anatomical organ injury during the surgical tooth extraction procedure is reported as a new complication during impacted third molar extraction.

Recovery of lingual nerve injury: retrospective observational study

INTRODUCTION: This study evaluated nerve recovery through retrospective study of patients with lingual nerve damage. PATIENTS AND METHODS: The patients who visited Seoul National University Dental Hospital for an injury to the lingual nerve from April 1988 to August 2009 were enrolled in this study (n=41). The relevance of various factors including the causes of damage, age, etc. was analyzed by the subjective improvement based upon questionnaires and the clinical records. The evaluation variants were a subjective assessment and neurosensory examination composed of the direction, contact threshold, two-point discrimination, pin prick, thermal discrimination and current perception threshold. RESULTS: The causes of lingual nerve damage were an extraction of the lower third molar (75.6%), local anesthesia (9.7%), incision and drainage (4.88%), trauma (2.44%). The evaluation of subjective prognosis exhibited no difference in sensory improvement depending on the cause, age and gender. Based upon the subjective evaluation, 44.7% of patients showed sensory improvement. The first hospital visit from injury was shorter in the group showing subjective improvement (3.41 months) than those showing no improvement (5.24 months) (P=0.301). Thirty six out of 41 patients were treated with only conservative therapy and 5 patients were treated by surgical intervention. Neurosensory examinations revealed improvement, although not statistically significant, and the degree was higher in the subjectively improved group. The contact threshold discrimination showed the highest correlation with subjective improvement (P=0.069). Most of the sensory recovery was gained within 12 months and the degree of improvement at the tip of the tongue was higher than that of the dorsum (P<0.001). CONCLUSION: The damaged lingual nerve improved at a rate of 44.7% and mostly within 12 months after the incident. There was no difference between the subjective prognosis and neurosensory examination depending on the cause of damage, age and gender, whereas the contact threshold discrimination was the best variant that reflected the subjective prognosis statistically.

An unusual communication between the mylohyoid and lingual nerves in man: Its significance in lingual nerve injury.

The mylohyoid nerve is the branch of the inferior alveolar nerve (IAN) which arises above the mandibular foramen. An abnormal communication between the mylohyoid nerve and lingual nerve (LN) was noted during the routine dissection of a male cadaver. Communicating branches between IAN and LN have been identified as a possible explanation for the inefficiency of mandibular anesthesia. The communication between mylohyoid and lingual nerve was found in this case after the LN passes in close relation to third molar tooth, which makes it more susceptible to injury during third molar extractions.

An unusual relationship between the inferior alveolar nerve, lingual nerve and maxillary artery / Una inusual relación entre los nervios alveolar inferior y lingual y la arteria maxilar

The knowledge of the neurovascular relationships of the infratemporal region is relevant in odontostomatology practice. In this article we present a case of atypical communication between the inferior alveolar nerve and lingual nerve associated with a change in relations with the maxillary artery, and discusses some clinical implications that these relations have on the development of the suplementary innervation and the anesthesia.

El conocimiento de las relaciones entre los elementos neurovasculares de la región infratemporal es relevante en la práctica odontoestomatológica. En el presente artículo presentamos el caso de una comunicación atípica entre el nervio alveolar inferior y el nervio lingual asociados a una variación en las relaciones con la arteria maxilar, y sediscut en algunas implicancias clínicas que estas relaciones tienen en el desarrollo de inervación suplementaria y en la práctica anestésica.

Anatomia dos ramos do nervo lingual em suíno / Anatomy of branches of nerve lingual in pigs

Neste trabalho, foram estudadas as ramificações e a distribuição do nervo lingual em 18 línguas de suínos adultos de ambos os sexos, sem especificação de raça. O material, colhido a fresco em rotina de abate, foi resfriado (4°C) para transporte, fixado em solução aquosa de formaldeído (7 por cento, 72 horas), imerso em solução aquosa de ácido nítrico (15 por cento, 72 horas), e dissecado sob lupa (RANSOR - II-20). Cada antímero dissecado possibilitou o registro dos ramos nervosos linguais primários, secundários e terciários presentes no interior das estruturas miofasciais do órgão, exibindo diferentes arranjos: o antímero esquerdo apresentou quatro a 10 ramos primários, quatro a 12 ramos secundários e zero a 11 ramos terciários. Já o antímero direito apresentou três a 8 ramos primários, zero a 11 ramos secundários e zero a 10 ramos terciários. Em 27,6 por cento das análises, os ramos linguais estabelecem associações com as fibras do nervo hipoglosso no antímero correspondente.

The distribution and ramifications of the lingual nerve of 18 tongues of adult pigs from both genders with no strain specification were studied. The material freshly collected in slaughter routine was cooled (4°C) for transportation, fixed in formaldehyde aqueous solution (7 percent, 72h), immerse in nitric acid aqueous solution (15 percent, 72h) and dissected with magnifying glass (RASOR, II-20). Each dissected antimere enabled the recording of primary, secondary and tertiary lingual nervous branches present inside the myofascial structure of the organ, exhibiting different arrangements: left antimere: 4 to 10 primary branches, 4 to 12 secondary antimeres and 0 to 11 tertiary branches; right antimere: 3 to 8 primary branches, 0 to 11 secondary antimeres and 0 to 10 tertiary branches. In 27.6 percent of analyses, the lingual branches established associations with the fibers of the hypoglossal nerve in the corresponding antimere.