Unilateral lingual nerve and hypoglossal nerve injury caused by a novel laryngeal mask airway: a case report

Abstract Cranial nerve injury by a laryngeal mask airway is rare but a serious complication. The nerve injuries must be prevented during the intubation using a laryngeal mask airway. We report a female patient who complained of tongue numbness, slurred speech, and slight difficulty in swallowing solid food after a hand surgery. She was then diagnosed with unilateral lingual nerve and hypoglossal nerve injuries. Extreme head rotation, relatively small oral cavity, and wide rigid composition at the lower part of the novel laryngeal mask probably resulted in cranial nerve injury.

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.

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.

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.

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.

Protocolo racional farmacológico para el tratamiento inmediato de lesiones nerviosas odontológicas: revisión bibliográfica y presentación de protocolo / Rationale pharmacological protocol for the immediate treatment of dental nerve lesions: review of the literature and protocol presentation

El objetivo de esta publicación fue realizar una revisión bibliográfica del conocimiento actual y la terapia farmacológica inmediata para el tratamiento de lesiones nerviosas sensitivas en el área buco-máxilo facial. Se realizó una descripción de las alteraciones nerviosas, desde su patogenia, epidemiología, etiología, clasificación, prevención, y medidas terapéuticas. A través del análisis de la literatura científica consultada, se realizaron recomendaciones clínicas, y se estableció un protocolo farmacológico para la atención de pacientes que padecen alteraciones nerviosas recientemente establecidas, que consiste en la administración de dexametasona oral durante 9 días, y la administración de ibuprofeno oral durante 21 días (AU)

The aim of this study was to review the actual knowledge and immediate pharmacological treatment, of oral and maxillofacial nerve injuries. Nerve injuries were described and categorized; and an epidemiological analysis was done. Preventive point of view and treatment options were described. Through the critical analysis of international literature, a pharmacological protocol to treat recent nerve injuries in patients is presented. It consists in the immediate administration of oral dexamethasone during 9 days, and oral ibuprofen during 21 days (AU)

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.

Neurilemmoma in the floor of the mouth: a case report

Neurilemmomas are well-encapsulated, benign, slow-growing tumors originating from Schwann cells of the nerve sheath surrounding cranial, peripheral, or autonomic nerves. Intraoral neurilemmomas are relatively rare and have a wide variety of morphologic and radiologic features. This makes differential diagnosis difficult, and only histopathological features can lead to a definitive neurilemmoma diagnosis. In this report, we present the case of a 30-year-old woman whose chief complaint was a solitary, nodular mass on the right floor of the mouth. After computed tomography and magnetic resonance imaging, we performed an incisional biopsy that showed the typical characteristics of a neurilemmoma. The mass was removed completely through an intraoral surgical approach. Despite losing a portion of the lingual nerve, the patient did not complain of any specific discomfort. Wound healing was uneventful and there were no signs or symptoms of recurrence.

Clinical application of the combined radical operation without breaking lower lip and mandible for tongue and lingual root carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical applicability and outcomes of the combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap for tongue and lingual root carcinoma.</p><p><b>METHODS</b>The operation with or without breaking lower lip and mandible was performed respectively in 245 patients (experimental group) and 120 patients (control group).</p><p><b>RESULTS</b>Removal of tumor and neck dissection were conducted successfully in all patients of two groups with no serious postoperative complication. With the follows-up of 6 to 36 months, in the patients of experimental group there was no recurrence for primary sites but 3 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, there was no damage to appearance, and no osteoradionecrosis occurred in the lymphnode positive cases after radiotherapy; in the patients of experimental group there was no recurrence for primary sites but 4 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, but there was apparent scar in neck and face, and osteoradionecrosis occurred in 11 of lymphnode positive cases.</p><p><b>CONCLUSIONS</b>The combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap is feasible for tongue and lingual root carcinoma (T2-T3), which reduces the risk for osteoradionecrosis in lymphnode positive cases after radiotherapy and keeps good appearance for patients.</p>

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.

Variations in the posterior division branches of the mandibular nerve in human cadavers

<p><b>INTRODUCTION</b>The lingual, inferior alveolar and auriculotemporal nerves, being branches of the posterior division of the mandibular nerve, mainly innervate the mandibular teeth and all the major salivary glands. Anomalous communications among these branches are widely reported due to their significance to various treatment procedures undertaken in the region. This study was performed as detailed exploration of the functional perspectives of such communicating branches would further enhance the scope of these procedures.</p><p><b>METHODS</b>A total of 36 specimens were dissected to examine the infratemporal region. The branches from the posterior division of the mandibular nerve--namely the lingual, inferior alveolar and auriculotemporal nerves--were carefully dissected, and their branches were studied and analysed for abnormal course.</p><p><b>RESULTS</b>Communication between branches of the posterior division of the mandibular nerve was observed in four specimens. In two of the four specimens, communication between the mylohyoid and lingual nerves was observed. A rare and seldom reported type of communication between the auriculotemporal and inferior alveolar nerves is described in this study. This communicating nerve split into two to form a buttonhole for the passage of the mylohyoid nerve.</p><p><b>CONCLUSION</b>Such communicating branches between nerves found in this study are developmental in origin and thought to maintain functional integrity through an alternative route.</p>

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...

Autonomic and cardiovascular effects of pentobarbital anesthesia during trigeminal stimulation in cats / 国际口腔科学杂志·英文版

Stimulation of the trigeminal nerve can elicit various cardiovascular and autonomic responses; however, the effects of anesthesia with pentobarbital sodium on these responses are unclear. Pentobarbital sodium was infused intravenously at a nominal rate and the lingual nerve was electrically stimulated at each infusion rate. Increases in systolic blood pressure (SBP) and heart rate (HR) were evoked by lingual nerve stimulation at an infusion rate between 5 and 7 mg·kg(-1)·h(-1). This response was associated with an increase in the low-frequency band of SBP variability (SBP-LF). As the infusion rate increased to 10 mg·kg(-1)·h(-1) or more, decreases in SBP and HR were observed. This response was associated with the reduction of SBP-LF. In conclusion, lingual nerve stimulation has both sympathomimetic and sympathoinhibitory effects, depending on the depth of pentobarbital anesthesia. The reaction pattern seems to be closely related to the autonomic balance produced by pentobarbital anesthesia.

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.

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.

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.

effect of dexamethasone on neuropraxia following third molar surgery

In this double blind controlled study, the effects of intramuscular Dexamethasone on neuropraxia development of inferior alveolar nerve and lingual nerve following the surgical removal ofmandib ular third molars were studied after 24 hours. Patients who were contraindicated to the use of steroid i.e. hypertensive, GIT ulcer, diabetics, bacterial infections, history of thromboembolic events, psychosis, patients taking other medication chronically and pregnant were excluded from this study. Out of total 200 hundred impactions cases, 100 cases received 8mg intramuscular dexamethasone one hour prior to surgical extraction but it was not given to other 100 cases of control group. The overall rate of paresthesia of lingual nerve was 15% and of the inferior alveolar nerve 6.5%. On comparison no statistical difference in neuropraxia within the dexamethasone group and control group was noted. P value for lingual nerve was 1.000 and for inferior alveolar nerve 0.390 so both had no significance statistically [p>0.05]

Lesão de nervo, anormalidade sensitiva e dor persistente em Implantodontia: devo remover o implante? / Nerve injury, sensorial abnormality, and persistent pain after dental implant procedures: should I remove the implant?

A Implantodontia atual permite reabilitação em diversos níveis de complexidade. Os procedimentos são relativamente seguros e previsíveis. As complicações, quando ocorrem, em geral são temporárias e de baixa gravidade. Entretanto, uma das situações mais angustiantes, tanto ao paciente quanto ao cirurgião-dentista, provavelmente é aquela relacionada à lesão de nervo, principalmente quando o paciente se queixa de anormalidades sensitivas, falta de adaptação com as próteses ou dor persistente na área operada ou no implante ou ainda na própria prótese. Felizmente, esta é uma complicação incomum, porém, quando presente pode ser altamente incapacitante, afetando a qualidade de vida do paciente. Esse tipo de complicação exige diagnóstico e tratamento precoces, muitas vezes especializados, e é uma ocorrência que gera ansiedade no paciente, pois nem sempre suas queixas são compreendidas; gera também desconforto no profissional menos experiente, pois ao exame não são observadas alterações morfológicas que justifiquem a queixa. Este artigo fez breve revisão da literatura vigente e apresenta um protocolo para abordagem desses pacientes pelo clínico generalista ou pelo não especialista em dor.

Osseointegration allows oral rehabilitation at several levels of complexity. The procedures are relatively safe and predictable. Complications are usually temporary and at low levels of severity. However, one of the most distressing situations, both to patient and dentist, is probably that related to nerve injury, especially when the patient complains of neurosensory abnormalities, non-adaptability to the prosthesis or persistent pain in the surgical area, in the "implant", or even in the "prosthesis". Fortunately, this complication is uncommon; however, it can be highly disabling, affecting the quality of life of patients. This type of complication requires early diagnosis and treatment, often specialized, and is an occurrence that creates anxiety in the patient, since their complaints are not always understood, and worries the dentist, as the physical examination does not show morphological changes which would explain the complaint. This article makes a brief review of current literature and presents a protocol for clinical management of these patients by general practitioners or non-pain specialists.

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.