RESUMEN
BACKGROUND: Dental malpractice claims, which pertain to legal actions against dentists accused of clinical negligence that caused harm to patients, have increased in the past ten years in South Korea. The claims are caused by complications, particularly trigeminal nerve injuries, resulting from various dental procedures. Medicolegal issues related to trigeminal nerve injury have not been previously described in South Korea. Therefore, in this study, we aimed to identify the general, dental, and judicial characteristics of closed dental malpractice claims. METHODS: This study was designed as a descriptive study. We collected the data of 51 closed claims related to trigeminal nerve injury resulting from dental procedures such as dental implant emplacement, tooth extraction, and local anesthesia. The claims were decided by courts in South Korea between 2016 and 2023. The general, dental, and judicial characteristics of the claims were analyzed retrospectively. RESULTS: The average claim resolution period was 4.2 (range: 1.47-8.39) years post-adverse events that occurred more frequently in dental clinics (68.6 %) than in dental (25.5 %) or general hospitals (5.9 %). Inferior alveolar (66.7 %) and lingual (17.6 %) nerves were injured following dental procedures. The duty to inform was breached in 68.6 % of claims. The dental procedure performed (P < 0.001) and the injured nerve (P < 0.001) were associated with the violation of the duty to care. CONCLUSION: To improve the quality of dental care services, the analysis of the adverse events using various resources including judgments should be strongly addressed.
Asunto(s)
Mala Praxis , Traumatismos del Nervio Trigémino , Humanos , Mala Praxis/estadística & datos numéricos , Mala Praxis/legislación & jurisprudencia , República de Corea/epidemiología , Estudios Retrospectivos , Traumatismos del Nervio Trigémino/epidemiología , Traumatismos del Nervio Trigémino/etiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Procedimientos Quirúrgicos Orales/efectos adversos , Procedimientos Quirúrgicos Orales/legislación & jurisprudencia , Extracción Dental/efectos adversosRESUMEN
Mit der Verbreitung von Zahnimplantaten ist die Zahl neurologischer Komplikationen gestiegen, wobei diese vor allem im Unterkiefer vorkommen. Verletzungen des Nervus alveo- laris inferior sind eine ernste Komplikation mit Inzidenzen für transiente Nervschäden bis zu 24% und persistierenden Schädigungen bis zu 11%.
Asunto(s)
Traumatismos del Nervio Trigémino , Humanos , Implantación Dental/efectos adversos , Implantación Dental Endoósea/efectos adversos , Implantes Dentales/efectos adversos , Urgencias Médicas , Complicaciones Posoperatorias/etiología , Traumatismos del Nervio Trigémino/etiologíaRESUMEN
BACKGROUND: Inferior alveolar nerve (IAN) injury is one of the complications of impacted lower mandibular third molar (LM3) extraction. Given the unknown prognosis of IAN injuries and limited treatment options, it is critical to understand the risk factors of IAN injury before LM3 extraction. PURPOSE: The purpose of the study was to identify risk factors associated with IAN injury after LM3 extraction. STUDY DESIGN, SETTING, SAMPLE: This was a prospective cohort study including patients who underwent LM3 extraction from May to December 2021 at the authors' institution. Patients with systemic diseases, previous maxillofacial surgeries, or sensory abnormalities were excluded. PREDICTOR VARIABLE: The predictor variable is composed of several risk factors. The variables were grouped into four categories: demographic, radiographic, procedure-related, and surgeon experience. MAIN OUTCOME VARIABLE(S): The outcome variable was postoperative neurosensory disturbance coded as present or absent and was measured at 1-month (transient) and 1-year (permanent). COVARIATES: Not applicable. ANALYSES: The measurement data were represented by mean and standard deviation. The association of each variable with the presence of an IAN injury was tested by the χ2 test. Statistical significance was accepted at P < .05. RESULTS: The study sample consisted of 705 patients (37.0% male) with an average age of 28.51 ± 6.51 years. A total of 17/705 (2.4%) and 4/705 (0.57%) patients developed transient and permanent IAN injuries. The results demonstrated that the following factors were associated with higher rates of transient injury: use of chisels during surgeries (6.4%; 95% confidence interval (CI): 2.7 to 12.3; P = .02; relative risk (RR) = 11.4), LM3s located below the IAN canal (8.7%; 95% CI: 4.3 to 15.7; P < .01; RR = 7.3), compressed contact between LM3s and the IAN canal (36.4%; 95% CI: 12.3 to 78.2; P < .001; RR = 25.4), and not using corticosteroids after surgeries (3.8%; 95% CI: 1.9 to 6.5; P = .03; RR = 3.1). The only factor associated with permanent injury was compressed contact between LM3s and the IAN canal (18.2%; 95% CI: 2.2 to 62.3; P < .001; RR = 48.2). CONCLUSION AND RELEVANCE: Close proximity between LM3s and IAN canal and the use of chisels increase the risk of transient IAN injury. Corticosteroid treatment may promote nerve recovery. Compressed contact between LM3s and IAN canal is the only risk factor for permanent injury.
Asunto(s)
Lesiones del Nervio Mandibular , Tercer Molar , Extracción Dental , Diente Impactado , Humanos , Tercer Molar/cirugía , Estudios Prospectivos , Diente Impactado/cirugía , Extracción Dental/efectos adversos , Factores de Riesgo , Masculino , Femenino , Adulto , Complicaciones Posoperatorias , Mandíbula/cirugía , Adolescente , Adulto Joven , Nervio Mandibular , Traumatismos del Nervio Trigémino/etiologíaRESUMEN
PURPOSE: To assess the impact of endoscope-assisted fractured roots or fragments extraction within the mandibular canal, along with quantitative sensory testing (QST) alterations in the inferior alveolar nerve (IAN). METHODS: Six patients with lower lip numbness following mandibular third molar extraction were selected. All patients had broken roots or fragments within the mandibular canal that were extracted under real-time endoscopic assistance. Follow-up assessments were conducted on postoperative days 1, 7, and 35, including a standardized QST of the lower lip skin. RESULTS: The average surgical duration was 32.5 min, with the IAN exposed in all cases. Two of the patient exhibited complete recovery of lower lip numbness, three experienced symptom improvement, and one patient remained unaffected 35 days after the surgery. Preoperative QST results showed that the mechanical detection and pain thresholds on the affected side were significantly higher than those on the healthy side, but improved significantly by postoperative day 7 in five patients, and returned to baseline in two patients on day 35. There were no significant differences in the remaining QST parameters. CONCLUSIONS: All endoscopic surgical procedures were successfully completed without any additional postoperative complications. There were no cases of deterioration of IAN injury, and lower lip numbness recovered in the majority of cases. Endoscopy allowed direct visualization and examination of the affected nerve, facilitating a comprehensive analysis of the IAN.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Estudios Retrospectivos , Hipoestesia/complicaciones , Hipoestesia/cirugía , Canal Mandibular , Traumatismos del Nervio Trigémino/etiología , Mandíbula/cirugía , Nervio Mandibular , Extracción Dental/efectos adversos , Extracción Dental/métodos , Tercer Molar/cirugía , Diente Impactado/cirugía , Radiografía Panorámica/métodosRESUMEN
Inferior alveolar nerve (IAN) injury is a severe complication associated with mandibular third molar (MM3) extraction. Consequently, the likelihood of IAN injury must be assessed before performing such an extraction. However, existing deep learning methods for classifying the likelihood of IAN injury that rely on mask images often suffer from limited accuracy and lack of interpretability. In this paper, we propose an automated system based on panoramic radiographs, featuring a novel segmentation model SS-TransUnet and classification algorithm CD-IAN injury class. Our objective was to enhance the precision of segmentation of MM3 and mandibular canal (MC) and classification accuracy of the likelihood of IAN injury, ultimately reducing the occurrence of IAN injuries and providing a certain degree of interpretable foundation for diagnosis. The proposed segmentation model demonstrated a 0.9 % and 2.6 % enhancement in dice coefficient for MM3 and MC, accompanied by a reduction in 95 % Hausdorff distance, reaching 1.619 and 1.886, respectively. Additionally, our classification algorithm achieved an accuracy of 0.846, surpassing deep learning-based models by 3.8 %, confirming the effectiveness of our system.
Asunto(s)
Traumatismos del Nervio Trigémino , Humanos , Traumatismos del Nervio Trigémino/etiología , Tercer Molar , Extracción Dental/efectos adversos , Nervio Mandibular , Probabilidad , MandíbulaRESUMEN
BACKGROUND: Neurosensory disturbance (NSD) is a common complication after sagittal split ramus osteotomy (SSRO) due to inferior alveolar nerve (IAN) injury. The impact of intraoperative nerve manipulation on NSD remains debated. PURPOSE: The purpose of this study was to evaluate the influence of IAN exposure and manipulation during SSRO on functional sensory recovery (FSR). STUDY DESIGN: This was a single-center, prospective cohort study of 40 patients undergoing SSRO at Mahidol University from December 2020 to December 2021. The inclusion criteria were patients aged 20-34, ASA Class I-II. The exclusion criteria were patients with systemic bone disease, history of head and neck or neurological pathology, previous SSRO, or incomplete data collection. PREDICTOR VARIABLE: Degree of intraoperative nerve manipulation was divided by the attending surgeon as follows; 1) Nerve fully encased in distal segment and not visible (NS); 2) Nerve encased in distal segment but partially visible (DS); and 3) Nerve partially encased in proximal segment and fully dissected free (PS). OUTCOME VARIABLES: The area of interest was divided into the lip and chin. The primary outcome was time to FSR. The secondary outcome was subjective patient report, using a visual analogue scale, compared to FSR. COVARIATES: The covariates were sex, age, skeletal diagnosis, degree of movement, and concomitant genioplasty/subapical procedure. ANALYSES: Kaplan-Meier survival analysis, Cox proportional hazards regression, and Mcnemar test were utilized. P-value < .05 was significant. RESULTS: In the lip, the median times to FSR were NS, 2 days; DS, 45 days; PS, 102 days. (Interquartile range: 77,127, 114, respectively) In the chin, the median times to FSR were NS, 23 days; DS, 92 days; PS, 87 days. (Interquartile range: 77, 161, 101, respectively.) Nerve manipulation significantly affected FSR in the lip and chin (P = .001, <0.001, respectively. Cox hazard ratios for DS and PS were lower compared to NS. Patients consistently reported more NSD compared to FSR as per Mcnemar test. CONCLUSION AND RELEVANCE: After SSRO, FSR in the lip is prolonged when the IAN is partially encased in the proximal segment and released. This raises the question of the efficacy of surgically releasing a partially encased IAN.
Asunto(s)
Osteotomía Sagital de Rama Mandibular , Traumatismos del Nervio Trigémino , Humanos , Osteotomía Sagital de Rama Mandibular/efectos adversos , Osteotomía Sagital de Rama Mandibular/métodos , Estudios Prospectivos , Mandíbula/cirugía , Traumatismos del Nervio Trigémino/etiología , Nervio Mandibular/cirugíaRESUMEN
BACKGROUND: Surgical extraction of the lower third molar (LTM) may trigger neurosensory injury of the inferior alveolar nerve, making extraction a real challenge. This study set out to assess whether is it possible to predict neurosensory alterations from preoperative imaging. MATERIAL AND METHODS: A total of 99 patients underwent 124 impacted lower third molar (ILTM) surgeries. Prior to surgery, panoramic and CBCT images were evaluated in an attempt to predict a neurosensory disturbance. Preoperative data (ILTM position, panoramic radiograph signs, inferior alveolar nerve (IAN) location and its contact with the ILTM roots) and intra/postoperative findings (extraction difficulty and sensitivity alterations) were recorded. Descriptive and bivariate data analysis was performed. Statistical comparison applied the chi-square test, Fisher test, and one-way ANOVA test. Statistical significance was established with a confidence interval (CI) of 95%. RESULTS: In 4.03% of cases, patients experienced neurosensory alterations. Of 124 ILTM positions in panoramic radiographs, 76 cases were considered to exhibit a potential neurosensory risk as they presented two or more types of superimposed relationships between ILTM and mandibular canal. Of these, alterations were reported in only three cases (3.95%). Of the 48 remaining ILTM images presenting only one sign, neurosensory alterations were observed in two cases (4.17%). No permanent alterations were recorded in any of the five cases observed. CONCLUSIONS: Within the limitations of the present study, prediction of neurosensory alterations prior to ILTM extraction by means of preoperative imaging did not show a significant statistical correlation with post-surgical incidence. Nevertheless, interruption of the canal´s white line (ICWL) or a diversion of the canal (DC) may predict an increased risk of IAN injury.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Tercer Molar/diagnóstico por imagen , Tercer Molar/cirugía , Estudios Prospectivos , Tomografía Computarizada de Haz Cónico , Cuidados Preoperatorios , Extracción Dental/efectos adversos , Diente Impactado/diagnóstico por imagen , Diente Impactado/cirugía , Diente Impactado/complicaciones , Radiografía Panorámica/efectos adversos , Radiografía Panorámica/métodos , Nervio Mandibular/diagnóstico por imagen , Traumatismos del Nervio Trigémino/etiología , MandíbulaRESUMEN
PURPOSE: The purpose of this study was to measure and compare coronectomy versus extraction in patients at increased risk for inferior alveolar nerve (IAN) injuries associated with third molar removal in terms of IAN injury and other complications. METHODS: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. We conducted a comprehensive literature search across six databases and the gray literature from July 15 to August 01, 2022. We employed Rayyan software to identify and remove duplicate articles to ensure data integrity. Our research followed the strategy patient (P), intervention (I), comparison (C), outcome (O), and study (S): (P) patients needing lower third molar surgery at higher risk of IAN injury; (I) surgery options, coronectomy or complete extraction; (C) comparisons included reduced risks of nerve injuries, postoperative complications (pain, infection, alveolitis), and increased risks of reoperation, root migration, and extraction; (O) desired outcomes were preventing nerve injuries and reducing other surgical complications; and (S) observational study designs (cohort, case-control). Excluded from consideration were studies involving teeth other than lower third molars, as well as reviews, letters, conference summaries, and personal opinions. To gauge the certainty of evidence, we employed the Grading of Recommendation, Assessment, Development, and Evaluation instrument, selecting the most current papers with the highest levels of evidence for inclusion. The primary outcome variable of our study centered on evaluating the incidence of IAN injury, and secondly, the lingual nerve (LN) injury, the postoperative pain, infection, localized alveolitis, the necessity for surgical reintervention, root migration, and extraction. These assessments were carried out with respect to their chosen operative technique for managing third molars, either coronectomy or extraction, as predictor variables. We also considered covariates such as age, gender, and the presence of systemic diseases in our analysis to account for potential confounding factors. The pooled data underwent rigorous analysis utilizing an inverse variance method with both random and fixed effect models by the "metabin" function in the R program's meta-package. Additionally, we assessed the risk of bias in the selected studies by utilizing the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data and the Critical Appraisal Checklist for Case Reports. RESULTS: Of the 1,017 articles found, after applying the inclusion and exclusion criteria, 42 were included in this study (29 cohort and 13 case-control studies), including 3,095 patients from 18 countries. The meta-analysis showed that coronectomy reduced the risk of IAN injury [OR (Odds Ratio): 0.14; 95% CI (confidence intervals): 0.06-0.30; I2 (inconsistency index) = 0%; P = .0001], postoperative pain (OR: 0.97; 95% CI: 0.33-2.86; I2 = 81%; P = .01), and alveolitis (OR: 0.38; 95% CI: 0.13-1.09; I2 = 32.2%; P = .01) when compared to complete tooth extraction. However, it also highlighted a greater risk of reintervention (OR: 5.38; 95% CI: 1.14-25.28; I2 = 0.0%; P = .01). CONCLUSIONS: This study has demonstrated that coronectomy is associated with a decreased risk for IAN injury and decreased pain and localized alveolitis when compared to complete tooth extraction. However, it is essential to acknowledge the higher likelihood of requiring reintervention with coronectomy. Therefore, clinicians should carefully consider the advantages and potential drawbacks of both techniques and tailor their choices to the unique clinical circumstances of each patient.
Asunto(s)
Traumatismos del Nervio Lingual , Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Tercer Molar/cirugía , Traumatismos del Nervio Trigémino/etiología , Traumatismos del Nervio Trigémino/prevención & control , Diente Impactado/etiología , Extracción Dental/efectos adversos , Traumatismos del Nervio Lingual/complicaciones , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Nervio Mandibular , Mandíbula , Corona del Diente/cirugía , Estudios Observacionales como AsuntoRESUMEN
THE PURPOSE: Of the study is to reduce the risk of postoperative neuropathy of the inferior alveolar nerve by improving diagnostic methods, assessment of individual topographic and anatomical features and extraction technique of impacted teeth adjacent to the mandibular canal. MATERIALS AND METHODS: According to the CBCT examination, orthopantomography and macroscopic examination of removed third molars roots (n=140) the relative position of the mandibular canal and the roots of the third molars were studied. RESULTS: Three variants of close mandibular canal and third molars position have been identified. In the lateral and apical nerve position, the root surface depressions were detected. With inter-radicular position fit, the mandibular canal and the nerve bundle form a «bed¼ in between impacted tooth roots. CONCLUSION: The injury of neurovascular bundle prognosis during extraction with an interadicular mandibular position depends on roots anatomy and their convergence degree. If the interradicular distance is less than the diameter of the mandibular canal, nerve injury during tooth extraction is inevitable, in such cases coronectomy is indicated.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Canal Mandibular , Tercer Molar/diagnóstico por imagen , Tercer Molar/cirugía , Traumatismos del Nervio Trigémino/diagnóstico por imagen , Traumatismos del Nervio Trigémino/etiología , Traumatismos del Nervio Trigémino/prevención & control , Diente Impactado/cirugía , Mandíbula/diagnóstico por imagen , Extracción Dental/efectos adversos , Nervio Mandibular/diagnóstico por imagenRESUMEN
BACKGROUND: The injury of the inferior alveolar nerve (IAN) is one of the most serious complications of impacted mandibular third molars (IMTMs) extraction. The influence of the root orientation of IMTMs on IAN injury is still controversial. A deeper understanding of the risk factors of IAN injury conduces to better prevention of IAN injury. This study aims to explore whether root orientation is an independent risk factor of IAN injury during IMTMs extraction using the statistical strategy of propensity score matching (PSM). METHODS: This retrospective cohort study included 379 patients with 539 cases of high-risk IMTMs screened by panoramic radiography and cone beam computed tomography. The IAN injury incidence after extraction of different groups of IMTMs was analyzed using the chi-square test or Fisher's exact test. The correlation between third molar root orientation and impaction depth/contact degree with IAN was evaluated by the Lambda coefficient. Based on PSM for balancing confounding factors including age, sex, impaction depth, and contact degree, the effect of root orientation on the incidence of IAN injury was further analyzed using Fisher's exact test. RESULTS: There were significant group differences in IAN injury incidence in impaction depth, root orientation, and contact degree of root-IAC before PSM. Root orientation was correlated with impaction depth and contact degree of root-IAC. After PSM, there were 9 cases with IAN injury and 257 cases without IAN injury. There were significant group differences between the buccal and non-buccal groups after PSM, and the risk of IAN injury was higher when the root was located on the buccal side of IAC (OR = 8.448, RR = 8). CONCLUSIONS: Root orientation is an independent risk factor of IAN injury, and the risk is higher when the root is located on the buccal side of IAC. These findings could help better evaluate the risk of inferior alveolar nerve injury before the extraction of IMTMs.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Tercer Molar/cirugía , Estudios Retrospectivos , Puntaje de Propensión , Traumatismos del Nervio Trigémino/epidemiología , Traumatismos del Nervio Trigémino/etiología , Tomografía Computarizada de Haz Cónico/métodos , Diente Impactado/cirugía , Nervio Mandibular , Mandíbula , Extracción Dental/efectos adversos , Radiografía Panorámica/métodosRESUMEN
INTRODUCTION: We hypothesize that the removal of mandibular third molars (M3) 6 months prior to a bilateral sagittal split osteotomy (BSSO) could allow the displacement of the inferior alveolar nerve (IAN) in a favorable lingual position. This study aimed to radiographically compare the position of IAN before and after M3 removal in patients with Class II malocclusion. MATERIALS AND METHOD: The CBCT images of 30 randomly selected patients (mean age 15.5 years, 19 females and 11 males) were segmented regarding the mandibular bone and the IAN canal. Mandibles were then superimposed and compared using 3D slicer (www.slicer.org). An orthonormal system was constructed, and the coordinates of IAN were assessed in the x- (horizontal axis), y- (depth axis), and z- (vertical axis) directions. RESULTS: The mean changes in x- and z-values were 0.37 %, -0.09 % for the right IAN, 0.07 %, and -0.10 % for the left IAN, respectively. Y-axis was the dimension the most impacted by the M3 removal with a mean variation of -11.96 % for the right IAN, and 0.45 % for the left nerve (p1=0.74 and p2=0.04, respectively). Three patients presented a change in the IAN position superior to 1 mm on at least one coordinate axis. We observed a more important change in x-values of the right IAN in male than in female (p = 0.04), and no significant modifications regarding the other dimensions. Finally, there was no correlation between the age of the patients and the changes in IAN position. CONCLUSION: This study confirms the absence of influence of mandibular third molar removal on the inferior alveolar nerve route prior to BSSO.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Adolescente , Femenino , Humanos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/cirugía , Nervio Mandibular/diagnóstico por imagen , Tercer Molar/diagnóstico por imagen , Tercer Molar/cirugía , Osteotomía , Diente Impactado/diagnóstico por imagen , Diente Impactado/cirugía , Traumatismos del Nervio Trigémino/diagnóstico , Traumatismos del Nervio Trigémino/etiología , Estudios RetrospectivosRESUMEN
PURPOSE: Coronectomy is an operation to manage impacted third molars (M3s) considered at high risk for mandibular nerve injury but long-term outcomes are still lacking. The purpose of this study was to estimate the risk of late complications occurring within 10 years following lower M3 coronectomy. METHODS: The investigators designed a prospective cohort study and enrolled a sample of 94 patients treated with coronectomy of third mandibular molars at the Unit of Oral and Maxillofacial Surgery of the University of Bologna, from 2009 to 2012. This follow-up study included all of the patients from the original study who completed 10 years of follow-up. The primary outcome variables is postoperative late complication occurring between 5 and 10 years after coronectomy coded as present or absent. Late complications were defined as root exposure, nerve injury, pulpitis, periapical infection, and reoperation. The secondary outcome variable was probing pocket depth. Covariates examined were age, smoking and type of M3 impaction. Descriptive statistical analyses were performed. RESULTS: The inception cohort was composed of 94 subjects who had 116 coronectomies (k) completed. The study cohort was composed of subjects with 10 years of follow-up and included 48 subjects (k = 60) with a mean age of 28.99 ± 8.9 years. Between years 5 and 10 of follow-up, 2 subjects (4%) have complications; all root exposures diagnosed at years 8 or 9 after surgery. In another case root removal was required for orthodontics reason. No case of nerve injury to the inferior alveolar nerve occurred, and no periapical infection was observed around the residual roots. The mean 10-year probing pocket depth was 3.31 ± 0.92 mm (1,66-5,66 mm). There were too few complications to identify risk factors for late complications. CONCLUSIONS: Within all the limitations of this study, the results of this prospective study imply that coronectomy is a useful surgical technique for the treatment of M3s at high neurological risk, to avoid nerve injury to the inferior alveolar nerve. In addition, after coronectomy, retained roots did not develop late infection or periapical infection in the long term. However, in a few cases, removal of retained roots was required at 10 years, due to root migration in the oral cavity. The risk for late complications is uncommon, but persistent.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Adulto Joven , Adulto , Estudios de Seguimiento , Estudios Prospectivos , Tercer Molar/cirugía , Traumatismos del Nervio Trigémino/epidemiología , Traumatismos del Nervio Trigémino/etiología , Incidencia , Corona del Diente/cirugía , Raíz del Diente/cirugía , Complicaciones Posoperatorias/epidemiología , Extracción Dental/efectos adversos , Diente Impactado/cirugía , Diente Impactado/complicaciones , Mandíbula/cirugía , Nervio MandibularRESUMEN
OBJECTIVES: Extraction of impacted mandibular third molars (IMTMs) is the most common surgery performed in the Department of Oral and Maxillofacial Surgery. Inferior alveolar nerve (IAN) injury is a rare but severe complication, and the risk is significantly higher in cases of IMTM near the inferior alveolar canal (IAC). The existing surgical method to extract such IMTMs is either not safe enough or is time-consuming. A better surgical design is needed. MATERIALS AND METHODS: From August 2019 to June 2022, 23 patients underwent IMTM extraction by Dr. Zhao at Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Nanjing University, and were found to have IMTMs in close proximity to the IAC. Due to high IAN injury risk, these patients underwent coronectomy-miniscrew traction to extract their IMTMs. RESULTS: The time between coronectomy-miniscrew insertion and complete removal of the IMTM was 32.65 ± 2.110 days, which was significantly shorter than that of traditional orthodontic traction. Two-point discrimination testing revealed no IAN injury, and no injury was reported by patients during follow-up. Other complications, such as severe swelling, severe bleeding, dry socket, and limited mouth opening, were not observed. Postoperative pain levels were not significantly higher in the coronectomy-miniscrew traction group than in the traditional IMTM extraction group. CLINICAL RELEVANCE: For IMTMs that are in close proximity to the IAC and must be extracted, coronectomy-miniscrew traction is a novel approach to minimize the risk of IAN injury in a less time-consuming way with a lower possibility of complications.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Canal Mandibular , Tercer Molar/cirugía , Traumatismos del Nervio Trigémino/prevención & control , Traumatismos del Nervio Trigémino/etiología , Extracción Dental/efectos adversos , Tracción/efectos adversos , Mandíbula/cirugía , Diente Impactado/cirugía , Nervio MandibularRESUMEN
OBJECTIVE: To assess whether differences exist in signs observed in 2D radiographs of mandibular third molars between a case group of patients with and a control group without permanent sensory disturbance of the inferior alveolar nerve (IAN) after removal. STUDY DESIGN: Three observers blinded to patient status assessed radiographs from the case group (n=162) and the control group (n=172). Two new signs, craniocaudal relation of the roots and the mandibular canal and position of the canal over the roots; and 4 "classic" signs, interruption of the white borders of the canal, darkening of the roots, narrowing of the canal lumen, and diversion of the canal over the roots were registered. Chi-square tests assessed differences in distribution of radiographic signs between the groups. Odds ratios expressed the association between radiographic signs and permanent sensory disturbance. Inter- and intraobserver reliability values were calculated. RESULTS: We found significantly more teeth with roots positioned inferiorly to the canal borders (P<0.001; OR 4.1-5.3) and with the canal superimposed over the upper or middle third of the roots (P<0.001; OR 2.6-3.9) in the case group than in the control group. Inter- and intraobserver reproducibility was excellent for roots inferior to the canal borders and fair to good for canal superimposition. CONCLUSIONS: Two radiographic signs are valid predictors of permanent sensory disturbance of the IAN in 2D radiographs.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Estudios de Casos y Controles , Reproducibilidad de los Resultados , Tercer Molar/diagnóstico por imagen , Tercer Molar/cirugía , Extracción Dental/efectos adversos , Factores de Riesgo , Traumatismos del Nervio Trigémino/etiología , Nervio Mandibular/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Radiografía Panorámica , Diente Impactado/diagnóstico por imagen , Diente Impactado/cirugía , Diente Impactado/complicacionesRESUMEN
Injuries to the mental nerve are not an uncommon complication in maxillofacial surgeries. Manipulation close to the mental nerve poses a great risk of nerve injury from drills, bone cutting and trimming burs, and oscillating/reciprocating saws. Nerve injuries can be painful and affect the patient's quality of life. The accompanying complication of the nerve injury depends on the severity of the damage inflicted and can range from transient hypoesthesia to neuropathic pain or trigeminal neuralgia. It is considered that direct injury to the nerve may lead to permanent damage and more severe postoperative clinical symptoms than indirect injuries caused by nerve stretching or during endosteal implant fixation. This technical note describes a technique for shielding the mental nerve and protecting it from rotary drill injury during mandibular inferior border recontouring, orthognathic surgeries, and mandibular body fracture fixation.
Asunto(s)
Traumatismos del Nervio Trigémino , Neuralgia del Trigémino , Humanos , Traumatismos del Nervio Trigémino/etiología , Traumatismos del Nervio Trigémino/prevención & control , Calidad de Vida , Nervio Mandibular/cirugía , Mandíbula/cirugíaRESUMEN
Tensionless adaptation of nerve ends is a challenging task in the repair of damaged inferior alveolar nerve (IAN). A new technique is introduced with posterior ostectomy of a mandibular distal segment after sagittal splitting for nerve bundle traction to tensionless anastomosis of nerve ends. We were able to create tensionless anastomosis of an IAN defect without autogenous or alloplastic graft using this method. This method is suitable for neurorrhaphy after neuroma removal in cases of IAN damage during dental procedures.
Asunto(s)
Traumatismos del Nervio Trigémino , Humanos , Traumatismos del Nervio Trigémino/etiología , Traumatismos del Nervio Trigémino/cirugía , Tracción , Nervio Mandibular/cirugía , Osteotomía Sagital de Rama Mandibular/métodos , Anastomosis QuirúrgicaRESUMEN
PURPOSE: A recently proposed modification of the sagittal split osteotomy (SSO) of the mandible places the horizontal medial cut 'low and short' of the lingula. The purpose of the study was to answer the following clinical question: Among patients undergoing mandibular setback procedures (≤ 8 mm) via SSO, does the placement of the medial horizontal osteotomy below the lingula (infralingular), when compared to placement above the lingula (supralingular), results in different neurosensory, bite force, and range of motion outcomes? MATERIALS AND METHODS: This was a single-center, double-blind, parallel-group study among patients undergoing mandibular setback by SSO (≤ 8 mm), between January 2021 and September 2022. Patients were randomly allocated in a ratio of 1:1 to the supralingular (control) and the infralingular (study) group. Primary outcome variables included neurosensory disturbance of the inferior alveolar nerve based on clinical neurosensory testing and severity graded using Zuniga and Essick's protocol, bite force, and maximum mouth opening evaluated postoperatively during the first week (T1), first month (T2), and third month (T3) of follow-up. Secondary outcome measures included the incidence of a bad split and distal segment interferences intraoperatively. Association between the variables was assessed using Pearson chi-squared test or Fisher's exact test based on the expected observations. A P value of ≤.05 was considered statistically significant. RESULTS: A total of 29 patients (58 osteotomies) were included in the study. Group 1 consisted of 15 patients (9 females and 6 males) with a mean age of 26.4 years. Group 2 consisted of 14 patients (8 females and 6 males) with a mean age of 25.9 years. Patients with severe neurosensory disturbance of the inferior alveolar nerve were more common in group 2 (n = 15, 53.6%) than group 1 (n = 4, 13.3%) at T1 (P value = .0001) and insignificant between the two groups at T2 (P value = .63) and T3 (P value = .99). Comparison of maximum mouth opening between the two groups at T1 (P value = .535), T2 (P value = .934), and T3 (P value = .703) and bite force at T1 (P = .324), T2 (P = .113), and T3 (P = .811) was not significant. CONCLUSION: Both SSO techniques have similar clinical outcomes among patients having mandibular setbacks (≤ 8 mm) for the variables studied.
Asunto(s)
Mandíbula , Traumatismos del Nervio Trigémino , Masculino , Femenino , Humanos , Adulto , Mandíbula/cirugía , Osteotomía , Osteotomía Sagital de Rama Mandibular/métodos , Nervio Mandibular , Traumatismos del Nervio Trigémino/etiologíaRESUMEN
PURPOSE: To analyse and quantify ocular surface parameters in patients with unilateral neurotrophic keratitis (NK) induced by trigeminal nerve injury post-neurosurgery. METHODS: The study included 26 unilateral NK patients who had undergone neurosurgery, and 20 matched normal controls. Demographic and clinical characteristics of all participants were collected and analysed. Slit-lamp examination, Cochet-Bonnet aesthesiometry, Keratograph 5 M, and LipiView interferometer were performed on both eyes of 17 mild NK patients. For nine moderate/severe NK patients, sub-basal nerve density was measured by in vivo confocal microscopy. RESULTS: Of the 26 patients, nine had acoustic neuroma, nine had trigeminal neuralgia, and eight had neoplasms. Facial nerve paralysis was observed in one of the 17 mild NK eyes (5.9%) and seven of the nine moderate/severe NK eyes (77.8%). Compared to contralateral and normal control eyes, 26 NK eyes showed significantly reduced sensitivity in five corneal regions (P < 0.05). Corneal sensitivity in moderate/severe NK eyes was significantly lower than in mild NK eyes (P < 0.05). Moderate/severe NK eyes had poor visual acuity, and their sub-basal nerve density was lower than that of the controls. The onset of the moderate/severe NK was from 0.5 to 24 months (median [Q1, Q3], 1 [0.5, 2.5] months) after neurosurgery. For the mild NK eyes, the number of total blinks, the first non-invasive tear breakup time (NITBUT) and average NITBUT were significantly lower than contralateral and normal control eyes (P < 0.05), and the number of partial blinks and partial blinking rate were significantly higher than the other two control groups (P < 0.05). CONCLUSIONS: Patients with NK induced by trigeminal nerve injury following neurosurgery had decreased corneal sensitivity to various degrees accompanied by increased partial blinks and shortened NITBUT. The severity of NK is related to the severity of the corneal sensory impairment. Facial nerve paralysis can worsen the clinical progression of NK. Trial registration Chinese Clinical Trial Registry (ChiCTR2100044068, Date of Registration: March 9, 2021).
Asunto(s)
Distrofias Hereditarias de la Córnea , Queratitis , Neurocirugia , Traumatismos del Nervio Trigémino , Humanos , Córnea/cirugía , Queratitis/diagnóstico , Queratitis/etiología , Microscopía Confocal , Parálisis , Traumatismos del Nervio Trigémino/diagnóstico , Traumatismos del Nervio Trigémino/etiologíaRESUMEN
PURPOSE: This prospective cohort study aimed to assess early root migration after a coronectomy of the mandibular third molar at 2 and 6 months after surgery. METHODS: We included all patients treated with a coronectomy of an impacted mandibular third molar. The primary outcome measure was the extent of postoperative root migration after 2 and 6 months. Migration was measured as the distance between the root complex and a fixed point on the inferior alveolar canal. The secondary aim was to identify factors (age, impaction pattern, and patient sex) that affected the extent of root migration. RESULTS: One hundred and sixty-five coronectomies were performed in 141 patients (96 females and 45 males; mean age 33.1 years, SD 16.0). The 2-month checkup was completed by 121 patients that received 141 coronectomies. The 6-month check-up was completed by 73 patients that received 80 coronectomies. The mean root migrations were 3.30 mm (SD 2.53 mm) at 2 months and 5.27 mm (SD 3.14 mm) at 6 months. In the 2-6-month interval, the mean root migration was 2.58 mm (SD 2.07 mm). The extents of migration were similar during the 0-2-month interval and the 2-6-month interval (p = 0.529). Younger age was associated with greater root migration, and females experienced significantly greater migrations than males (p = 0.002). CONCLUSION: Roots migrated more rapidly in the first two postoperative months, compared to the 2-6-month interval. Age was negatively correlated with the extent of root migration, and females showed significantly greater migrations than males.
Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Masculino , Femenino , Humanos , Adulto , Estudios de Seguimiento , Tercer Molar/cirugía , Estudios Prospectivos , Traumatismos del Nervio Trigémino/etiología , Raíz del Diente/diagnóstico por imagen , Mandíbula/cirugía , Corona del Diente , Nervio Mandibular , Diente Impactado/diagnóstico por imagen , Diente Impactado/cirugía , Extracción Dental/efectos adversosRESUMEN
OBJECTIVE: To compare a three-dimensional (3D) artificial intelligence (AI)- driven model with panoramic radiography (PANO) and cone-beam computed tomography (CBCT) in assessing the risk of inferior alveolar nerve (IAN) injury after mandibular wisdom tooth (M3M) removal through a within-patient controlled trial. METHODS: From a database of 6,010 patients undergoing M3M surgery, 25 patients met the inclusion criteria of bilateral M3M removal with postoperative unilateral IAN injury. In this within-patient controlled trial, preoperative PANO and CBCT images were available, while 3D-AI models of the mandibular canal and teeth were generated from the CBCT images using the Virtual Patient Creator AI platform (Relu BV, Leuven, Belgium). Five examiners, who were blinded to surgical outcomes, assessed the imaging modalities and assigned scores indicating the risk level of IAN injury (high, medium, or low risk). Sensitivity, specificity, and area under receiver operating curve (AUC) for IAN risk assessment were calculated for each imaging modality. RESULTS: For IAN injury risk assessment after M3M removal, sensitivity was 0.87 for 3D-AI, 0.89 for CBCT versus 0.73 for PANO. Furthermore, the AUC and specificity values were 0.63 and 0.39 for 3D-AI, 0.58 and 0.28 for CBCT, and 0.57 and 0.41 for PANO, respectively. There was no statistically significant difference (p>0.05) among the imaging modalities for any diagnostic parameters. CONCLUSION: This within-patient controlled trial study revealed that risk assessment for IAN injury after M3M removal was rather similar for 3D-AI, PANO, and CBCT, with a sensitivity for injury prediction reaching up to 0.87 for 3D-AI and 0.89 for CBCT. CLINICAL SIGNIFICANCE: This within-patient trial is pioneering in exploring the application of 3D AI-driven models for assessing IAN injury risk after M3M removal. The present results indicate that AI-powered 3D models based on CBCT might facilitate IAN risk assessment of M3M removal.