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The number of dental implants placed and restored every year is increasing across the world. However, there has been an increase in the number of reports with implant-related surgical complications in which the inferior alveolar nerve injury is the most serious one. This surgical problem can be avoided by using cone beam computed tomography (CBCT), three-dimensional (3D) implant planning software, and computer-aided design and computer-aided manufacturing (CAD-CAM) technology such as stereolithographic surgical guides. The objective of this report is to present the clinical and radiologic findings of a female patient with the injury of inferior alveolar nerve after implant insertion where CBCT has not been used prior to implant placement.

Purpose: In bilateral sagittal split osteotomy (BSSO), the risk of lesion of the inferior alveolar nerve (IAN) is important. The aim of this study was to investigate the situation of the IAN in the area of the BSSO in preoperative 158 CBCT., Methods: The situation of the mandibular canal (MC) has been studied in six coronal sections (one section each 4 mm) from the proximal root of the second mandibular molar. The height of the MC related to the height of the mandible, and the horizontal distance between the MC and the lateral cortical plate related to the mandibular width have been determined in each section. The cancellous bone width has been measured allowing to determine a cancellous bone ratio., Results: The variability of the MC was high, depending mainly on the cancellous bone ratio which was higher when the IAN was deep. When a third molar was present, the MC was lower in the area of the third molar., Conclusions: To decrease the risk of injuring the IAN in BSSO, the evaluation of the cancellous bone ratio by a preoperative CBCT may be proposed to adapt the surgical technique to the anatomy.

Background: The lag time between injury and treatment (LTIT) plays an important role in reduction of complications in mandibular fractures. The aim of this study was to measure the effect of LTIT on recovery of the inferior alveolar nerve (IAN) neurosensory disturbances (NSDs) following surgical management of mandibular body fractures., Methods: This was a prospective cohort study. Patients who had a unilateral mandibular body fracture with paresthesia were studied. Paresthesia was evaluated by 2-point discrimination (TPD) test, brush stroke test and self-reporting before and 6 months after the surgical procedure., Results: Forty-five patients were studied. There was a correlation between LTIT and TPD test result and self-reported paresthesia at 6 months, postoperatively (P = 0.001). Fifteen patients (33.3%) had complete improvement in NSD 6 months after treatments (group 1) and 30 patients (group 2) had hyposthesia (N = 17, 37.77%) and paresthesia (N = 13, 28.88%). There was a significant difference in LTIT between groups 1 and 2 at 6 months postoperatively (P = 0.001). Cox regression model demonstrated the hazard ratio increased significantly for self-reported NSD when treatment was done 10 days after trauma (P = 0.001, confidence level = 95%)., Conclusion: It seems that conduction of open reduction with internal rigid fixation shortly after mandibular fracture may shorten the recovery time of NSDs of the IAN following mandibular body fractures.

Although various animal studies have indicated that sensory nerves played an important role in bone metabolism and nerve injury could impair the process of bone remodeling, the actual effect of sensory nerve rupture on human bones remains unclear. The aim of this preliminary study was to investigate the effect of inferior alveolar nerve (IAN) rupture on mandibular bone remodeling of patients underwent bilateral sagittal split ramus osteotomy (BSSRO).Ten patients with unilateral IAN rupture during BSSRO were involved in this study. Neurosensory examinations were employed to assess the sensory function of bilateral IAN. The remodeling process of the post-operational mandible was evaluated by panoramic radiographs and computed tomography (CT) scans.Neurosensory examinations indicated that nerve rupture resulted in significant hypoesthesia at the IAN-rupture side. Assessment of panoramic radiographs showed no evident alterations of bone structure at the IAN-rupture side of mandible. Evaluation of CT images also indicated no statistical difference in bone density and thickness between IAN-rupture side and contralateral side.Accordingly, our study indicated that IAN rupture may not significantly impair the short-term bone remodeling process of human mandible.

The aim of this study was to find out if juxta-apical radiolucency (JAR) is a reliable risk factor for injury to the inferior alveolar nerve (IAN) during removal of lower third molars. We designed a cohort study of patients whose dental panoramic tomograms (DPT) had shown JAR before complete removal of lower wisdom teeth. The outcome variable was postoperative permanent neurosensory disturbance of the IAN. A total of 39 patients (50 lower third molars) were identified and screened for permanent neurosensory disturbance. None reported any permanently altered sensation 18 months after the operation. Based on our group, the presence of JAR does not seem to be a reliable predictor of the risk of permanent injury to the IAN during removal of lower third molars., (Copyright © 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The osteotomy in a bilateral sagittal split ramus osteotomy (BSSRO) is made in close proximity to the inferior alveolar nerve (IAN), so direct damage to the nerve and irreversible neurosensory deficit may result. The aim of this study was to compare the incidence of injury to the nerve when a conventional osteotomy using an osteotome was made, with that after manual twist splitting. We retrospectively reviewed the casenotes of 769 consecutive patients who had bilateral SSRO either alone or with a simultaneous maxillary procedure by a single surgeon from May 2009 - October 2016. Patients were divided into two groups based on the technique used. Those in the first group had conventional split osteotomy using an osteotome and hammer for splitting (conventional group, 736 sides), and in those in the second group the manual twist technique was used (manual group, 802 sides). Patients who sustained Sunderland fifth degree injuries were identified from an existing record of nerve repairs. Fisher's exact test was used to evaluate the significance of the number of injuries to the nerve in each group. Conventional osteotomy and hammer-assisted SSRO resulted in 8/736 (1.1%) injuries to the IAN, whereas the manual twist splitting technique resulted in 1/802 injuries (0.1%). Our results confirm that the manual twist splitting technique significantly reduces the incidence of injury to the IAN, though the overall incidence was low., (Copyright © 2018 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The sagittal split osteotomy (SSO) is an indispensable tool in the correction of dentofacial abnormalities. In elective orthognathic surgery, it is important that surgeons inform patients about the risk of complications related to inferior alveolar nerve damage and unfavorable split. The purpose of this article is to describe a novel, hybrid technique to SSO by combining a reciprocating saw and piezoelectric devices with several advantages over traditional "pure" methods (osteotomies performed by reciprocating saw or piezoelectric devices only) in terms of precision, rapidity, easier splitting, and decreased complications related to inferior alveolar nerve damage and bad split with reduced overall morbidity. The level of evidence was Level IV, therapeutic study., Competing Interests: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Introduction: Post-operative injury of the marginal mandibular branch of the facial nerve is consider a complication in neck dissection and can be related to different factors including traction, devascularisation or the conduction block due to diathermy., Material and Methods: Prospective, crossover study including patients treated bilateral selective neck dissection of level IIa during a 12 months-period, was performed to evaluate the efficacy of the Hayes-Martin manoeuvre to prevent nerve injury during the use of cold or monopolar diathermy dissection., Results: 20 patients met the inclusion criteria (40 neck dissections). Just one case of a right temporal MMN weakness in the post-operative period was observed (1/40 = 2,5%). There were no cases of permanent marginal mandibular nerve weakness using the Hayes-Martin manoeuvre Conclusion: The Hayes-Martin manoeuvre is a safe way to preserve MMN during neck dissection of level IIa, regardless of the type of dissection.

Introduction: This study was designed to quantify the important anatomical landmarks and the path of the inferior alveolar nerve (IAN) within the human mandibular body and ramus, in particular with reference to the bilateral sagittal split osteotomy (BSSO)., Materials and Methods: Four hundred and eleven CT scans were studied, 299 of these were involved in determining the position of lingula; and 230 were involved in determining the course of IAN in the mandibular molar region, namely from the mesial of the mandibular first molar to the distal of the mandibular second molar; 118 were involved with both measurements., Results: On average, the lingula was located 17.0 ± 2.2 mm from the external oblique ridge; 11.6 ± 2.0 mm from the internal oblique ridge; 17.2 ± 2.7 mm from the sigmoid notch; and 15.6 ± 1.9 mm from the posterior border of the mandible. The course of the IAN in the mandibular molar region was found to descend vertically from the distal of the mandibular second molar (7) to reach its lowest point between the first and second molars (6 and 7), and then ascend towards the mesial of the first molar (6). Horizontally, the IAN was found to traverse medially between the distal of the 7 and the middle of the 7, and then changes its path laterally towards the mesial of the 6., Conclusion: Precise knowledge of the individual's position of the IAN will help surgical planning.

The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal. The patient presented at the Department of Oral and Maxillofacial Surgery with a persistent total anaesthesia of the lower lip and chin after two months. 2D panoramic view and 3D CT-scan examination highlighted the overfilling into the mandibular canal with a more than 50% stenosis of the canal and a consequently significant compression of the dental pedicle. A surgical decompression of the inferior alveolar nerve was performed through an inferior vestibular approach, using PiezoSurgery ® . The tooth was conserved. After a period of 8days, paraesthesia of the lower lip and chin appeared. Thermoalgic sensitivity was recovered at 1month. At 3months postoperatively, the patient had recovered protopathic and epicritic sensitivity. Dental prosthetic rehabilitation was finally achieved one year postoperatively. The authors discuss the physiopathology of nervous injuries during dental procedures, and further strategies in the case of persistent neurologic disorders., (Copyright © 2017. Published by Elsevier Masson SAS.)

A retrospective cohort study was performed to assess the clinical usefulness of combination assessment using computed tomography (CT) images in patients undergoing third molar extraction. This study included 85 patients (124 extraction sites). The relationship between cortication status, buccolingual position, and shape of the inferior alveolar canal (IAC) on CT images and the incidence of inferior alveolar nerve (IAN) injury after third molar extraction was evaluated. IAN injury was observed at eight of the 124 sites (6.5%), and in five of 19 sites (26.3%) in which cortication was absent+the IAC had a lingual position+the IAC had a dumbbell shape. Significant relationships were found between IAN injury and the three IAC factors (cortication status, IAC position, and IAC shape; P=0.0001). In patients with the three IAC factors, logistic regression analysis indicated a strong association between these factors and IAN injury (P=0.007). An absence of cortication, a lingually positioned IAC, and a dumbbell-shaped IAC are considered to indicate a high risk of IAN injury according to the logistic regression analysis (P=0.007). These results suggest that a combined assessment of these three IAC factors could be useful for the improved prediction of IAN injury., (Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

This retrospective study compared the incidence of long-term inferior alveolar nerve injury for positional screws and miniplate fixation of bilateral sagittal split osteotomies carried out in 2 hospitals in Scotland. The study involved a mixture of mandibular setback and advancement surgery. The outcome of neurosensory deficit (NSD) was solely based on subjective assessment by the surgeons and patients' reported alteration in sensation. Numbness, tingling and any alterations in sensation beyond 6 months were considered long-term inferior alveolar nerve injury. This study was conducted on 28 sagittal split osteotomies (group 1) which were fixed with three upper border fixation screws and 36 sagittal split osteotomies (group 2) which were fixed with upper border sliding plate. The reported and documented neurosensory deficits were analysed. The difference in the number of cases of long-term inferior alveolar nerve injury between the 2 methods was 10.3%; the 95% confidence interval for the difference was [-2.94 to 23.5], p = 0.1612. Upper border plate was associated with more long-term NSD but there is insufficient evidence to prove that one method was more superior to the other. The need for a prospective randomized trial was highlighted., (Copyright © 2016 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to compare orthopantomography (OPG) and computed tomography (CT) accuracy in predicting inferior alveolar nerve (IAN) injury after lower wisdom teeth extraction., Methods: Twenty-three patients with completely impacted lower third molars were enrolled in this study and OPG and CT exams were obtained before surgical intervention. Finally, a total of 26 lower third molars were extracted and cases of paresthesia following a IAN lesion have been registered. Then, OPG and CT images of the same patients have been randomly submitted to four experienced oral surgeons (with a seniority of at least 5 years) who were required to predict the possibility of a IAN injury by only evaluating the radiological exams. The images were anonymous and have been submitted to the surgeons without an order avoiding to influencing the answers. The agreement between the predicted and the real outcomes was statistically evaluated using the positive predictive value (PPV), the negative predictive value (NPV), Sensitivity, Specificity and the Spearman's rank correlation coefficient., Results: A perfect agreement between OPG-based prevision and the real development of paresthesia due to IAN injury has been observed. This agreement was only moderate when considering CT images., Conclusions: OPG is a first-level diagnostic exam that provides enough information for predicting IAN lesions after impacted lower third molars surgery. CT is a second-level radiological exam that provides more information on roots morphology and on the amount of the contiguity between roots and mandibular canal resulting useful in performing a minimally invasive surgery.

Aim and Objectives: The purpose of this study was to evaluate how different exposures of the V3 nerves during orthognathic surgery impact neurosensory disturbances., Methods: The study included 127 patients who underwent either bilateral sagittal split osteotomy (BSSO) or BSSO with maxillary le Fort 1. They were divided into 6 groups, identified by the quantity of V3 nerve exposure. All patients were examined in a pre-op period and again after 1, 3, 6 months post-op. The standardized tests used were to clarify the objective and subjective neurosensory status of the exposed nerve. Neurosensory evaluation included; a pin prick test, the 2 points discriminator, light touch, warm and cold tests, and blunt discrimination. They were all done bilaterally on the lower lip area., Results: In only 2 patients the nerve was damaged during surgery and thus they were not included in this study. In 10.2% of patients there was no nerve exposure, 25.2% had longitudinal vestibular segment nerve exposed, 22.8% had the longitudinal upper-vestibular segment exposed, 20.5% had the longitudinal lower-vestibular segment exposed, 14.2% had the longitudinal upper-lower-vestibular segment exposed, and in 7.1% of patients the nerve was totally exposed. Given the estimated time of 1 month there was 100% recovery in patients whose nerve was unexposed. Considering the other patients, the authors had a variable number of patients who did not recover completely., Conclusion: The authors estimate a correlation between the recovery time and the quantity of the exposed nerve. There is a high incidence of neurosensory disturbance in the lower lip and chin after BSSO and intraoperative quantity of nerve exposure.

Iatrogenic injury in oral surgery is the most frequent cause of sensory disturbance in the distribution of the inferior alveolar nerve (IAN) and mental nerve.Inferior alveolar nerve damage can occur during third molar extraction, implant location, orthognathic surgery, preprosthetic surgery, salivary gland surgery, local anesthetic injections or during the resection of benign or malignant tumors.Injuries to the IAN can be caused also by endodontic treatment of mandibular molars and premolars when filling material is forced into the tooth and mandibular canal.The sensory disturbances that could follow a damage of the IAN could be hypoesthesia, dysesthesia, hyperesthesia, anesthesia, and sometimes a painful anesthesia that strike ipsilateral lower lip, chin, and teeth. These can undermine life quality by affecting speech, chewing, and social interaction.Treatment of these complications is sometimes difficult and could consist in observation or in surgical decompression of the involved nerve to relieve the patient's symptoms and improve sensory recovery. The most debated points are the timing of intervention and the effective role of decompression in clinical outcome-improvement.The purpose of this article is to show authors' experience with 2 patients treated with microsurgical nerve decompression to remove endodontic material from the mandibular canal and providing also a comprehensive review of the literature.

Objectives: The objective of the study was to evaluate the feasibility of a standardized Quantitative Sensory Testing (QST) protocol extra- and intraoral in patients to detect and quantify sensory disturbances of the inferior alveolar nerve due to the proximity of implantation procedures to the inferior alveolar nerve canal., Material and Methods: Patients who had obtained an implant placement were examined by implementing a comprehensive QST protocol for extra- and intraoral use. The study included 33 patients after implant placement in the lower jaw and one patient suffering from an inferior alveolar nerve injury. Patients were tested bilaterally (chin and mucosal lower lip)., Results: Comparing the implanted vs. the control side, QST parameters revealed no significant neurophysiological changes in all parameters. Evaluating the development of sensory disturbances in dependency of the proximity of the implant to the inferior alveolar nerve canal, mechanical QST parameters showed no significant correlation. The mean distance of the inserted implant to the inferior nerve canal was 2.65 ± 1.75 mm. In the case of one patient suffering from impairment of the nerve function due to implant placement, we found abnormal sensory responses to touch coexisting with numbness and temperature algesia., Conclusions: Monitoring of trigeminal nerve fiber functions by QST intra- and extraoral is feasible to evaluate oral sensory pattern after implantation procedures. Sensory disturbances of the inferior alveolar nerve were shown to be avoided by keeping an average safety zone of 2.65 mm between implant and nerve., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We describe the removal of a lower second molar tooth in which preoperative cone-beam computed tomography (CBCT) showed that the inferior alveolar nerve (IAN) was encased in the distal apex of the root of the tooth. During operation the nerve was found to be entirely separate from the apex of the root and not involved. With the wider use of CBCT in the treatment planning of dentoalveolar surgery, this case represents a cautionary tale to the clinician on reliance on clinical imaging and software in guiding the decision making process., (Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: Contemporary management of ablative jaw defects includes not only hard and soft tissue reconstruction, but also restoration of neurosensory function. The goal of this study was to determine the outcomes of immediate reconstruction of long-span defects (≥50 mm) of the inferior alveolar nerve (IAN) after ablative mandibular resection using allogeneic nerve grafts., Materials and Methods: A retrospective cohort study of patients who underwent immediate reconstruction of IAN gaps of at least 50 mm with allogeneic nerve graft (AxoGen Avance, Alachua, FL) at a single academic medical center by a single surgeon (M.M.) from September 2013 to March 2015 was completed. Demographic and clinical data were collected for each patient and analyzed using clinical neurosensory testing and were reported using the Medical Research Council Scale (MRCS) for functional sensory recovery. In addition, patient subjective perception of neurosensory recovery was recorded using a visual analog scale (VAS). Subjective (VAS) and objective (MRCS) measurements of functional sensory recovery were recorded and compared across the study population. In addition, examined demographic and clinical data included patient age, gender, pathology, length of nerve allograft, and follow-up period., Results: Of 12 with nerve repairs, 7 patients met the inclusion criteria. The average age was 34.7 years (range, 18 to 61 yr) and 71.4% were men. All IAN defects resulted from resection of mandibular pathology (6 benign lesions, 1 malignant lesion). Six of the 7 IAN defects were reconstructed with a 70-mm nerve allograft, and 1 nerve defect was reconstructed with a 50-mm graft. Mean follow-up time was 17.7 months (range, 10 to 27.5 months). Mean VAS score reported was 3.7 (range, 0 to 7). In addition, 85.7% of patients displayed return of some superficial pain and tactile sensation without over-response (S3), with 14.3% displaying good stimulation localization (S3+). The patient who displayed S3+ recovery underwent reconstruction with the 50-mm graft. Only 1 of the 7 patients had no neurosensory recovery (S0)., Conclusions: Immediate reconstruction of the IAN with allogeneic nerve grafting of long-span defects (≥5 cm) is a viable and predictable option to achieve useful functional sensory recovery., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the neurosensory outcome of management of damaged inferior alveolar nerves caused by endodontic overfilling and to assess the efficacy of delayed surgical intervention., Methodology: Nine patients who underwent surgical removal of extruded endodontic material were included. All patients were evaluated for neurosensory function using a set of standardized tests. The outcome of surgical intervention was evaluated through patient interview and quantitative statistical analysis., Results: Surgical procedures included foreign body removal, microsurgical external/internal decompression, excision of neuroma followed by nerve repair, and excision of damaged nerve segment with interpositional nerve graft. Seven of the nine patients had significant improvement according to the follow-up neurosensory assessment. Four patients reported significant improvement, three patients reported mild improvement and two patients reported no appreciable improvement in the Visual Analog Scale (VAS). Two patients who reported no appreciable improvement in VAS also did not achieve FSR. In these patients, calcium hydroxide was spread widely along the IAN and a surgical approach was obtained via sagittal spit osteotomy. The mean time to reach FSR was 222.7 (±41.8) days with a range of 106-397 days. In the early repair group who received surgery within 60 days, three out of five patients achieved FSR in a mean time of 198.0 (±76.2) days. The mean time to FSR in all four subjects who received surgical attention over 60 days after injury was 241.3 (±139.8) days with a range of 106-397 days. As all four cases in the late repair group with limited amount of nerve injury achieved FSR, only 3 of 5 early repair cases with wide-spread injury achieved a similar outcome., Conclusion: The results of this case series confirmed the notion that surgical management of the inferior alveolar nerve is effective in the treatment of nerve injuries caused by endodontic extrusion of calcium hydroxide paste. Delayed surgical repair of the inferior alveolar nerve can be indicated and helpful for the neurosensory recovery of damaged IAN, however, the surgical management was less effective in case of widespread nerve injuries., (© 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Objective: To evaluate the influence of the anatomic position and intraoperative exposure of the inferior alveolar nerve on neurosensory disturbance (NSD) in sagittal split ramus osteotomy., Study Design: The anatomic factors of the nerve were measured on preoperative three-dimensional computed tomography in 98 patients. The intraoperative nerve exposure was assessed. NSD was evaluated for 1 year after surgery. The correlations between NSD and the factors were analyzed., Results: The NSD decreased as the lateral marrow space from the nerve increased (P < .01). The complete nerve exposure increased NSD by 7.6 times (P = .01). The nerve exposure increased as the buccal plate thickness increased (P = .01) and decreased as the vertical marrow space from the nerve increased (P = .01)., Conclusions: The nerve exposure and the lateral marrow space from the nerve affected NSD. The buccal plate thickness and the vertical marrow space indirectly affected NSD through nerve exposure., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Mandibular fractures are amongst the most common facial fractures and are usually treated by open reduction and internal fixation (ORIF). Inferior alveolar nerve (IAN) injuries are seen frequently in mandibular fractures as well as after ORIF of these fractures due to the exposition and the close proximity of the nerve during fracture reduction. Therefore the continuity of the IAN can be disrupted. Permanent injury to the IAN can result in diminished quality of life. This retrospective study was designed to objectively analyse the incidence and the outcome of pre- and postoperative mental nerve hypoesthesia after ORIF of mandibular fractures., Material and Methods: Patients who were consecutively treated at the Department of Cranio-Maxillofacial and Oral Surgery of the University Hospital Zurich between 2004 and 2010 with mandibular fractures who underwent ORIF were included. Follow-up period was 12 months. Demographic, pre-, peri- and postsurgical data were tabulated and statistically evaluated using the χ(2) test and the Kruskall-Wallis-Test., Results: 340 patients met the inclusion criteria. 27% of the study population presented with postinjury (preoperative) mental nerve hypoesthesia, 46% suffered from purely postoperative hypoesthesia and 27% showed no nerve damage. Complete recovery was seen in 70% of all cases, partial recovery in 20% of the cases and less than 10% suffered from a permanent (>12 months) IAN damage. Mandibular angle fractures were accompanied with significantly higher rates of hypoesthesia (79% vs. 68%). Recovery rate was significantly worse in older patients, when preoperative hypoesthesia was present (66% vs. 73%) and in patients with multiple fractures in proximity to the IAN (36% vs. 52%). Mandibular body fractures showed worse recovery rates than fractures that did not affect the body (44% vs. 52%)., Conclusion: The present study shows that IAN injury is seen frequently in mandibular fractures. Mental nerve hypoesthesia may influence quality of life. Nerve continuity may not be preserved due to the initial trauma or may result as a postoperative complication. Nevertheless the results of this study show a high potential for full recovery., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

A prospective study on 100 patients presented with a mesioangular impacted mandibular third molar in close proximity to the inferior alveolar nerve canal (IANC) was done to evaluate the efficacy of tooth sectioning in reducing the incidence of inferior alveolar nerve (IAN) injury during their surgical removal. The patients were divided into two groups: group A, where tooth sectioning was not performed, and group B, where tooth sectioning was performed. Patients were recalled 7 days, 15 days, 30 days, 3 months, and 6 months postoperatively for evaluation of nerve injury and its recovery. A total of 13 patients suffered from nerve damage out of which 10 patients (10/50 or 20 %) belonged to group A and 3 patients (3/50 or 6 %) belonged to group B. All patients showed complete recovery from nerve damage within 6 months except 1 patient. The result of the study showed that tooth sectioning significantly reduces the incidence of nerve damage by 14 %. Deviation of the IANC, increased depth of the impacted tooth, intraoperative hemorrhage within socket/nerve exposure, and increased duration of procedure were found to be the significant risk factors associated with nerve injury.

Purpose: The aim of this article is to present a referred clinical case of an inferior alveolar nerve laceration during the insertion of a dental implant in the mandible, that came to our attention after the injury., Materials and Methods: A 71-year-old female was treated by a colleague in order to be rehabilitated with a fixed implant-supported prosthesis for her missing teeth in positions 44, 45 and 46. After implant site osteotomy in region 46, the speed of the surgical motor was not changed; as a consequence, the implant was inserted at 1200 rpm and intruded into the mandibular canal, causing the laceration of the neurovascular bundle., Results: During the first 2 weeks after surgery the patient complained of paresthesia in the mental and lower lip area, with labial ptosis and drooling. After 14 days, the paresthesia reduced and mucosal and gingival normosensitivity was detected; however, the patient complained about hyperesthesia of the lower inside lip. After 21 days, the lower lip tone and function were almost completely restored and the paresthesia was further reduced, however the hyperesthesia persisted., Conclusions: It is extremely important to pay attention to preventing neurological complications through proper preoperative planning, careful execution of the surgical techniques and correct management of instruments and motor speed settings. The latter procedure should be double-checked by both the operator and the assistant.

Aim: The risk factors associated with inferior alveolar nerve damage during third molar surgery were investigated., Material and Methods: Surgeries performed during a period of 50 months by a single expert surgeon were reviewed. Only those surgeries that met the selected inclusion criteria were considered for this study. The following tests were applied for the statistical analysis: the Kolmogorov-Smirnov test, the principal components analysis, the Mann-Whitney U test, the two-tailed exact Fisher test and the Bonferroni sequential correction., Results: The surgical difficulty index, multi-rooted third molars and changes in the inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage., Conclusions: Computed tomography is mandatory when the nerve is superimposed on the tooth root on the ortopantomography. SCIENTIFIC RATIONALE FOR STUDY: Lower third molar extraction is one of the most common procedures in oral and maxillofacial surgery, and it is burdened by the risk of inferior alveolar nerve damage. Understanding which factors are able to predict this complication is therefore essential in correctly programming surgery., Principal Findings: Surgical difficulty index, multi-rooted third molars and changes in inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage., Practical Implications: If, on the orthopantomography, the nerve is superimposed on the tooth root, a computed tomography is mandatory to define all of these variables.

Purpose: This prospective observational cohort study sought to determine the prevalence of inferior alveolar nerve (IAN) injury after mandibular fractures before and after treatment and to elucidate factors associated with the incidence of post-treatment IAN injury and time to normalization of sensation., Materials and Methods: Consenting patients with mandibular fractures (excluding dentoalveolar, pathologic, previous fractures, or mandibular surgery) were prospectively evaluated for subjective neurosensory disturbance (NSD) and underwent neurosensory testing before treatment and then 1 week, 1.5, 3, 6, and 12 months after treatment., Results: Eighty patients (men, 83.8%; mean age, 30.0 yr; standard deviation, 12.6 yr) with 123 mandibular sides (43 bilateral) were studied. Injury etiology included assault (33.8%), falls (31.3%), motor vehicle accidents (25.0%), and sports injuries (6.3%). Half the fractures (49.6%) involved the IAN-bearing posterior mandible; all condylar fractures (13.0%) had no NSD. Treatment included open reduction and internal fixation (ORIF; 74.8%), closed reduction and fixation (22.0%), or no treatment (3.3%). Overall prevalence of IAN injury was 33.7% (95% confidence interval [CI], 24.8-42.6) before treatment and 53.8% (95% CI, 46.0-61.6) after treatment. In the IAN-bearing mandible, the prevalence was 56.2% (95% CI, 43.2-69.2) before treatment and 72.9% (95% CI, 63.0-82.7) after treatment. In contrast, this prevalence in the non-IAN-bearing mandible was 12.6% (95% CI, 4.1-21.1) before treatment and 31.6% (95% CI, 20.0-43.3) after treatment. Factors associated with the development of post-treatment IAN injury included fracture site and gap distance (a 1-mm increase was associated with a 27% increase in odds of post-treatment sensory alteration). Time to normalization after treatment was associated with type of treatment (ORIF inhibited normalization) and fracture site (IAN-bearing sites took longer to normalize)., Conclusion: IAN injury was 4 times more likely in IAN-bearing posterior mandibular fractures (56.2%) than in non-IAN-bearing anterior mandibular fractures (12.6%). After treatment, IAN injury prevalence (in 12 months) was higher (72.9% in posterior mandible, 31.6% in anterior mandible)., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to evaluate the predictive value of panoramic radiography on inferior alveolar nerve (IAN) injury after extraction of the mandibular third molar., Methods: Relevant studies up to 1 June 2014 that discussed the association of panoramic radiography signs and post-mandibular third molar extraction IAN injury were systematically retrieved from the databases of PubMed, Embase, Springerlink, Web of Science and Cochrane library. The effect size of pooled sensitivity, specificity, positive likelihood ratios (PLR), negative likelihood ratios (NLR) and diagnostic odds ratio (DOR) with their 95% confidence intervals (CI) were statistically analysed with Meta-disc 1.4 software., Results: Nine articles were included in this meta-analysis. The pooled estimates of sensitivity and specificity were 0.56 (95% CI: 0.50-0.61) and 0.86 (95% CI: 0.84-0.87), respectively. The overall PLR was 3.46 (95% CI: 2.02-5.92) and overall NLR was 0.58 (95% CI: 0.45-0.73). The pooled estimate of DOR was 6.49 (95% CI: 2.92-14.44). The area under the summary receiver operating characteristic curve was 0.7143 ± 0.0604., Conclusions: The meta-analysis indicated that interpretation of panoramic radiography based on darkening of the root had a high specificity in predicting IAN injury after mandibular third molar extraction. However, the ability of this panoramic radiography marker to detect true positive IAN injury was not satisfactory., (© 2015 Australian Dental Association.)

Extreme variation in the reported incidence of inferior alveolar nerve (IAN) disturbances suggests that neurosensory disturbances after orthognathic surgery have not been evaluated adequately. Here we review the reported incidence of IAN injury after orthognathic surgery and assess recently reported methods for evaluating sensory disturbances. A search was conducted of the English-language scientific literature published between 1 January 1990 and 31 December 2013 using the Limo KU Leuven search platform. Information on various aspects of assessing IAN injury was extracted from 61 reports. In 16 reports (26%), the incidence of injury was not indicated. Preoperative IAN status was not assessed in 22 reports (36%). The IAN assessor was described in detail in 21 reports (34%), while information on the training of the assessors was mentioned in only two reports (3%). Subjective evaluation was the most common method for assessing neurosensory deficit. We conclude that the observed wide variation in the reported incidence of IAN injury is due to a lack of standardized assessment procedures and reporting. Thus, an international consensus meeting on this subject is needed in order to establish a standard-of-care method., (Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Introduction: During implantology procedures, one of the most serious complications is the damage of the inferior alveolar nerve, which may result in neurosensory disturbances (NSD). Panoramic radiographs have been considered for a primary evaluation to determine the bone height and implant-mandibular canal distance., Materials and Methods: One thousand five hundred ninety-seven panoramic radiographs of patients, who were treated with 3608 dental implants in Erciyes University, Oral and Maxillofacial Hospital between 2007 and 2012, were examined. Forty-eight implants were determined to be near the mandibular canal using a 2-dimensional software program., Results: A total of 48 implants were closer than 2 mm to the mandibular canal. A range of 0 to 1.9 mm distance was detected between the mandibular canal and these implants. Fourteen implants (29.16%) placed in a distance less than 1 mm to the mandibular canal, and 34 (70.83%) between 1 and 2 mm. One patient had NSD., Conclusion: Determination of the dental implant length using panoramic radiography is a reliable technique to prevent neurosensory complications. However computed tomography or cone-beam computed tomography based planning of dental implants may be required for borderline cases.

Purpose: To document adverse neurosensory changes in the inferior alveolar nerve (IAN) and mental nerve (MN) after surgical mandibular fracture treatment and to identify risk factors associated with these changes., Materials and Methods: A retrospective study of patients surgically treated for mandibular fractures. The primary study variable was the postoperative change in IAN/MN neurosensory examination after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement and number of miniplates placed at each fracture site. Appropriate statistics were computed., Results: 209 patients with 293 fractures were analysed. One hundred twenty fractures (41%) were located between the lingula and mental foramen, and 173 fractures (59%) were located distal to the mental foramen. Two hundred seventeen (41%) were displaced by 5 mm or more. In 38 fractures (13%), the IAN/MN neurosensory status worsened after treatment. In a multivariate model, fracture displacement, operator inexperience and two plate fixation were associated with a statistically significant risk (P ≤ 0.05) for postoperative deterioration of IAN/MN sensation., Conclusion: Fixation with two miniplates, fracture displacement of 5 mm or more and operator inexperience were associated with an increased risk for deterioration of the IAN/MN neurosensory status after treatment of mandibular fractures., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The extent to which neurosensory disturbance (NSD) affects patients after bilateral sagittal split osteotomy (BSSO) was investigated 1 year postoperatively. An additional aim was to identify related factors., Materials and Methods: In this prospective study, the fate of the mandibular nerve during BSSO was recorded. The predictor variable was the degree of nerve injury during BSSO, and the outcome variable was the effect of NSD 1 year postoperatively. Statistics were computed and a P value less than .05 was considered significant., Results: Forty-one patients (27 women; average age, 37 yr) completed the study. Of these patients, 90.2% had NSD, but most (89.2%) were satisfied with the treatment and would choose it again. The NSD was greater when the nerve had been manipulated more during surgery. The 4 patients with visible nerve lacerations had severe NSD and were unsatisfied with the treatment at the endpoint., Conclusions: Although NSD was frequent 1 year after BSSO, most patients were satisfied with the treatment. However, a risk for severe NSD or neuropathic pain does exist in a small group of patients. These patients should be identified at an early stage so that proper medical and supportive treatment can be initiated. If necessary, a multidisciplinary pain center should be consulted. The importance of accurate patient information preoperatively cannot be overstated., (Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Inferior alveolar nerve injuries are a recognised complication of mandibular third molar extractions. This paper describes the different types of nerve injuries that may occur. A differential of possible causes is provided and an approach to the immediate and follow-up management is outlined. The prognosis of such injuries is reviewed so that patients can be informed of the possible postoperative outcome. The algorithm shows the timeline for monitoring/referring and the included tables outline the advantages and disadvantages of surgery versus watchful waiting.

Objective: The aim of this study was to evaluate the influence of different splitting techniques, namely, "mallet and chisel" versus "spreading and prying", used during bilateral sagittal split osteotomy (BSSO) on postoperative hypoesthesia outcomes., Study Design: We systematically searched the PubMed and Cochrane databases (from January 1957 to November 2012) for studies that examined postoperative neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) after BSSO., Results: Our initial PubMed search identified 673 studies, of which, 14 met our inclusion criteria. From these 14 studies, 3 groups were defined: (1) no chisel use (4.1% NSD/site), (2) undefined chisel use (18.4% NSD/site), and (3) explicit chisel use along the buccal cortex (37.3% NSD/site)., Conclusion: Study heterogeneity and a frequent lack of surgical detail impeded our ability to make precise comparisons between studies. However, the group of studies explicitly describing chisel use along the buccal cortex showed the highest incidence of NSD. Moreover, comparison of the study that did not use chisels with the 2 studies that explicitly described chisel use revealed a possible disadvantage of the "mallet and chisel" group (4.1% versus 37.3% NSD/site). These results suggest that chisel use increases NSD risk after BSSO., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

We present two cases of apical extrusion of non-setting, calcium hydroxide paste which had been placed as an interappointment root canal dressing during routine endodontic treatment resulting in tissue necrosis of a large part of the mandible. Surgical intervention consisted of resections in both instances. In relation to the cases presented, a systematic review of similar cases in the literature between 1980 and April 2013 was conducted which resulted in eight cases meeting the criteria outlined. As with the two presented cases, half of these eight cases showed serious adverse effects and the use of an injectable system had most often been related to apical extrusion. Consequently, great care should be taken when applying the paste into the canal system., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives: To investigate the prevalence and morphological parameters of lingual concavity, and whether these factors are related to a higher risk of inferior alveolar nerve (IAN) injury when performing an immediate implant surgery in posterior mandible region., Methods: The CBCT images from 237 subjects (1008 teeth) were analysed the shape of the mandibles (C, P, U type), dimensional parameters of lingual concavity (angle, height, depth), and its relation to inferior alveolar canal (IAC) (A, B, C zone), RAC (distance from root apex to IAC) and probability of IAN injury. Multiple logistic regression modelling to determine the odds ratio of variables that made an important contribution to the probability of IAN injury and to adjust for confounding variables., Results: The U type ridge (46.7%) and the most concave point located at C zone (48.8%) are most prevalent in this region. The mandibular second molar presents highest risk for IAN injury than other tooth type (p<0.001), which were 3.82 times to occur IAN injury than the mandibular second premolar. The concave point located at A zone and B zone were 7.82 and 3.52 times than C zone to have IAN damage, respectively. The probability of IAN injury will reduce 26% for every 1mm increase in RAC (p<0.001)., Conclusions: The tooth type, morphological features of lingual concavities, and RAC are associated with risks of IAN injury during immediate implant placement., Clinical Significance: Pre-surgical mapping of the IAC and identification of its proximity relative to the lingual concavity in the posterior mandible regions may avoid unpleasant complications, specifically when performing immediate implant procedures., (Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.)

The present study compared the use of cone beam computerized tomography (CBCT) images and intra-oral radiographs in the placement of final implant drills in terms of nerve damage to cadaver mandibles. Twelve cadaver hemimandibles obtained from 6 cadavers were used. Right hemimandibles were imaged using peri-apical radiography and left hemimandibles using CBCT, and the images obtained were used in treatment planning for the placement of implant drills (22 for each modality, for a total of 44 final drills). Specimens were dissected, and the distances between the apex of the final implant drill and the inferior alveolar neurovascular bundle and incisive nerve were measured using a digital calliper. Nerves were assessed as damaged or not damaged, and the Chi-square test was used to compare nerve damage between modalities (P < 0.05). Nerve damage occurred with 7 final drills placed based on peri-apical radiography (31.8%) and 1 final drill placed using CBCT images (4.5%). The difference in nerve damage between imaging modalities was statistically significant (P = 0.023), with CBCT outperforming intraoral film in the placement of final implant drills ex vivo. In order to prevent nerve damage, CBCT is recommended as the principal imaging modality for pre-implant assessment.

Purpose: Morphologic evaluation of computed tomographic images is an important assessment tool before surgical removal of the lower third molar (LM3). The aim of this study was to ascertain whether the shape of the inferior alveolar canal (IAC) is a reliable predictor for inferior alveolar nerve (IAN) injury during M3 surgery., Materials and Methods: This prospective study assessed samples with a high risk of IAN injury during M3 surgery based on orthopantomographic examination. The predictor variables were demographic factors (patient's age and gender), anatomic factors (angulation of the tooth), and radiographic factors (cortication status, buccolingual position, shape of the IAC, number of roots, and root shape). The outcome variable was IAN injury. The relation between predictor and outcome variables was analyzed using the Fisher exact test and a logistic regression model., Results: One hundred sixty-nine LM3s (115 patients) were analyzed. IAN injury was observed in 12 of 115 patients and 13 of 169 LM3s (7.7%). All 13 cases with IAN injury exhibited absence of cortication. A dumb-bell-shaped IAC was considered a useful predictor for IAN injury (sensitivity, 69.2%; specificity, 84.6%). In cases with absence of cortication, logistic regression analysis indicated that a dumb-bell-shaped IAC was closely related to IAN injury (P = .005)., Conclusion: The cortication status and shape of the IAC are reliable predictors for IAN injury at M3 surgery. Cases exhibiting absence of cortication and a dumb-bell-shaped IAC should be recognized as presenting a high risk of IAN injury at M3 surgery., (Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Our aim was to answer the question: "Among patients at high risk of injury to the inferior alveolar nerve (IAN) after removal of 3rd molars, what factors are associated with postoperative neurosensory deficits?" We organized a retrospective, two-center study and enrolled a group of subjects who were at increased risk of injury to the IAN after removal of 3rd molars because radiographic findings indicated a risk on panoramic radiography that was high enough to warrant preoperative computed tomography (CT). The primary outcome variable was postoperative injury to the IAN. We used descriptive, bivariate, and multivariate analyses to assess the significance of differences, and probabilities of less than 0.05 were accepted as significant. We studied 149 subjects who had 235 3rd molars removed. Their mean (SD) age was 31 (11) years and 25/235 (11%) of 3rd molars were associated with injury to the IAN. In the multiple logistic regression model, increasing age (odds ratio (OR) 1.05, 95% CI 1.01-1.1, p=0.04), female sex (OR 5.3, 95% CI 1.6-16.9, p=0.005), and the size (mm) of the cortical perforation in the inferior alveolar canal (IAC) viewed on the coronal CT cut (OR 1.3; 95% CI 1.0-1.6, p=0.03) were associated with an increased risk of postoperative injury to the IAN. Age, sex, and the size of the perforation in the IAC on the coronal CT were associated with an increased risk of injury to the IAN. These findings may help to guide recommendations for treatment of patients at high risk of injury to the IAN during removal of 3rd molars., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. All rights reserved.)

Our aim was to explore the relation between the site of the mandibular canal and neurosensory impairment after extraction of impacted mandibular third molars. We organised a retrospective study of 537 extractions in 318 patients in which the affected tooth was intersected by the mandibular canal. This was verified by cone-beam computed tomography (CBCT), and we analysed the relation between the site of the canal and the likelihood of injury to the inferior alveolar nerve (IAN) after extraction of the third molar. The relation between the position of the root of the tooth and the mandibular canal was categorised into 4 groups: I=root above the canal; II=on the buccal side; III=on the lingual side; and IV=between the roots. The overall rate of neurosensory impairment after extraction was 6% (33/537). It occurred in 9/272 patients (3%) in group 1, 16/86 (19%) in group II, and in 8/172 (5%) in group III. There was no neurosensory impairment in group IV where the canal was between the roots. There were significant differences between group II and groups I and III (p<0.01), but not between groups I and III (p=0.32). The risk of damage to the inferior alveolar nerve is increased if third molars intersect with the mandibular canal, particularly on its buccal side., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Trigeminal nerve injury is a rare, but serious complication of a common procedure, which results in a clinically relevant problem that deserves attention. The emergence of microsurgical repair of trigeminal injury has provided clinicians with treatment options for patients who experience persistent neurosensory deficits. The area of microsurgical repair of trigeminal nerves is now in its adolescence. While great strides have been made in the field since its conception, it is certain that a new generation of oral and maxillofacial surgeons wil bring further progress to the field. In the future, better quantitative sensory testing methods, more accurate imaging modalities, and advances in surgical technique will certainly improve the management of patients with impacted third molars. As clinicians, every day we are confronted with the management of impacted third molars. It is important to evaluate each patient individually with an appropriate clinical and radiographic exam. Every patient should be informed of the relative risks and benefits of third molar removal and a joint decision should be reached between the clinician and patient regarding ideal treatment. However, even with ideal management, complications will occur. If a patient does present with signs of a nerve injury the clinician should carefully document the neurosensory deficit and monitor the patient over time. If the patient exhibits a significant sensory deficit for more than one month a referral for evaluation to a tertiary care center capable of surgical repair of the injury is recommended. The occurrence of a "trigger" or Tinel's like sign is improtant as an indication for surgery but may not occur for a month after injury.

Aims: To explore the impact of trigeminal nerve injuries on quality of life, including the effect of pain on psychological and affective function., Methods: An observational, cross-sectional survey design was employed. Fifty-six patients with inferior alveolar nerve injury (IANI) and 33 patients with lingual nerve injury (LNI) completed standardized self-report measures of pain intensity, pain catastrophizing, self-efficacy to cope with pain, and mood, in addition to generic and oral health-related quality of life (HRQoL) indicators. The impact of pain severity on these aspects of psychosocial function was examined. Summary statistics were calculated for all measures and compared with norms or values of other relevant studies, when available, using t tests. The impact of pain severity on these aspects of psychosocial function was examined using analysis of variance and hierarchical multivariate regression models., Results: The majority of patients reported pain associated with their nerve injury (86%). Nerve injury had a significant impact on all investigated domains, and this was closely linked with reported pain levels. Patients with severe pain showed particularly elevated levels of depression and pain catastrophizing, as well as substantially reduced HRQoL and coping efficacy levels. Pain intensity level was a significant predictor in all models except anxiety, uniquely contributing between 17% and 26% of variance to the prediction of pain catastrophizing, depression, coping efficacy, and generic and oral HRQoL., Conclusion: Traumatic injury to the trigeminal nerve is associated with a substantial patient burden, particularly in patients who experience severe neuropathic pain as part of their condition. These findings highlight the need to identify, develop, and evaluate more effective treatments for neuropathic pain in trigeminal nerve injury that will not only provide clinically meaningful reductions in pain but also improve patients' quality of life.

In this study we investigated the relationships among the risk factors for inferior alveolar nerve injury (IANI), and the difference between preoperative imaging findings on panoramic radiographs and computed tomography (CT), by univariate and multivariate analyses. We determined the following to be significant variables by multivariate analysis: panoramic radiographic signs, such as the loss of the white line of the inferior alveolar canal or the diversion of the canal; excessive haemorrhage during extraction; and a close relationship of the roots to the IAN (type 1 cases) on CT examination. CT findings of type 1 were associated with a significantly higher risk (odds ratio 43.77) of IANI. In addition, many panoramic findings were not consistent with CT findings (275 of 440 teeth; 62.5%). These results suggest that CT findings may be able to predict the development of IANI more accurately than panoramic findings. Panoramic radiography alone did not provide sufficiently reliable images required for predicting IANI. Therefore, when the panoramic image is suggestive of a close relationship between the impacted tooth and the IAN, CT should be recommended as a means of conducting further investigations., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Prediction of neurosensory deficit in the lower lip and chin after sagittal split ramus osteotomy (SSRO) is challenging. This study aimed to elucidate factors related to the development and improvement of neurosensory disturbance (NSD) after SSRO with respect to surgical procedure and the anatomical and structural characteristics of the craniomaxillofacial skeleton. Subjects comprised 50 patients treated by a single experienced surgeon. Anatomical data and landmarks were obtained by computed tomography (CT) imaging. There was a significant difference between patients with or without NSD for the surgical space on the medial side of mandibular ramus 1 week after SSRO (P=0.006). Less than 15.0mm between the lingula and mandibular notch (relative risk, 6.7; 95% CI, 1.7-33.8) and 195.0mm(2) or more space on the medial side of the mandibular ramus (relative risk, 17.2; 95% CI, 3.9-100.4) indicated a significant risk of NSD development at 6 months postoperatively. These results suggested that the development of NSD is related to the surgical space on the medial side of the mandibular ramus and subsequent manipulation of the inferior alveolar nerve (IAN) in that region. Limited periosteal degloving prevents excessive stretching of the IAN during SSRO, thus lowering NSD incidence., (Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: This study reports and analyzes a large series of patients with neurosensory deficiency related to the placement of dental implants (DIs) and resulting in liability claims (LCs)., Methods: From 1998 to 2009, there were 92 LCs related to persistent altered sensation post DI placements in Israel. Patients' demographics, year and source of LCs, interval between the procedure that resulted in a neurosensory deficiency and the LC, qualifications of the surgeon, preoperative imaging modality, DI length, available alveolar bone for DI placement, placement site, timing of DI placement (immediately after tooth extraction or after socket healing), and treatment after the diagnosis of neurosensory deficiency were recorded and analyzed., Results: There were 21 cases during the first 5 years of the study (mean 4.2/year) and 63 cases (mean 12.6/year) over the following 5 years. Thirty LCs were issued during the second postoperative year and 15 LCs after >5 years. Most LCs (76%) involved procedures that were planned and performed according to radiographs and 24% after computed tomography. Sixty-five percent of the LCs were performed by general dental practitioners and 35% by specialists. More than one DI was performed during the surgical procedure that resulted in a neurosensory deficiency in 73 LCs (79.3%), and the DI was >10 mm in 55 (59.8%) cases., Conclusions: LCs for DIs that result in a neurosensory deficiency pose a legal risk to the practitioner long after the injury has occurred.

Purpose: To evaluate the interference of radiographic factors in the appearance of sensory deficit related to inferior alveolar nerve (IAN) after third molars (3Ms) removal., Methods: A prospective, double-blind, observational, unicentric study was performed with 126 patients submitted to a surgical procedure of lower 3Ms removal in the period from March to October/2011. Collected data included gender, age, eruption stage of 3Ms, position/angle of 3Ms (Pell-Gregory and Winter classifications, respectively), presence/absence of radiographic signs of 3Ms proximity with the inferior alveolar canal and surgical technique. Occurrence evaluation of the IAN injury was performed on the seventh postoperative day through pin-prick, two-point discrimination and brush directional stroke tests., Results: Predominant radiographic signs were: narrowing of the inferior alveolar canal (68.25%), darkening of root (46.82%) and diversion of the canal (31%). None of the patients presented sensory loss. Sixty-one (48.41%) of the cases had at least one or two radiographic signs of proximity with NAI. Forty-seven (37.3%) had 3 or more signs, and 18 (14.29%) did not have any radiographic signs of proximity to mandibular canal., Conclusion: There was not a positive correlation between presence of radiographic signs of 3Ms with IAN proximity and postoperative neurosensory disorders occurrence.

Objectives: Inferior alveolar nerve (IAN) is the most commonly injured nerve (64.4%) during implant treatment. At present, no standardized protocol exists for clinicians to manage IAN injury related with implant surgery. Therefore, the purposes of the present article were to analyze the reasons for nerve injury and to propose guidelines in managing IAN injury., Material and Methods: Patients with IAN sensory disturbances after implant treatment were recruited for the study. Sixteen patients, eight men and eight women, with a mean age of 52.2 ± 8.1 years participated in this study. Patient examination, treatment, and IAN sensory function recovery monitoring were performed following six-step IAN injury during dental implant surgery (IANIDIS) protocol. The control group was composed of 25 healthy volunteers who never had IAN sensory disturbances or any trauma in the maxillofacial region., Results: The IAN sensory disturbances were scored as following: 5 (31.25%) had hyperalgesia and 11 (68.75%) expressed hypoalgesia. The mean asymmetry index (AI) was calculated for each patient and varied from 0.6 to 3.2. Overall, 31.3% of nerve injury patients were classified as mild, 31.3% as moderate, and remaining 37.5% as severe injury. All patients were successfully treated with proposed IANIDIS protocol., Conclusion: The most frequent (50%) risk factor for IAN injury was intraoperative bleeding during bone preparation. The most common (56.3%) etiological risk factor of nerve injury was dental implant. A six-step protocol aimed at managing patients with IAN injury, during dental implant surgery, was a useful tool that could provide successful treatment outcome., (© 2011 John Wiley & Sons A/S.)

Bilateral sagittal split osteotomy (BSSO) is an effective and commonly used treatment to correct mandibular hypo- and hyperplasia. Hypoesthesia of the inferior alveolar nerve (IAN) is a common complication of this surgical procedure. This prospective multi-centre study aimed to determine the incidence of neurosensory disturbances of the IAN after BSSO procedures performed without the use of chisels. Our study group comprised 158 patients, with a follow-up period of 1 year, who underwent BSSO (with or without Le Fort I) that incorporated the use of sagittal split separators and splitters but no chisels. The percentage of BSSO split procedures that resulted in IAN damage was 5.1%. The percentage of patients (without genioplasty) who experienced IAN damage was 8.9%. The concomitant genioplasty in combination with BSSO was significantly associated with hypoesthesia. Peri-operative removal of the wisdom tooth or a Le Fort I procedure did not influence post-operative hypoesthesia. We believe that the use of splitting forceps and elevators without chisels leads to a lower incidence of persistent post-operative hypoesthesia 1 year after BSSO of the mandible, without increasing the risk of a bad split., (Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The study evaluates the incidence of inferior alveolar nerve injuries in mandibular fractures, the duration of their recovery, and the factors associated with them. Fifty-two patients with mandibular fractures involving the ramus, angle, and body regions were included in this study; the inferior alveolar nerve was examined for neurological deficit posttraumatically using sharp/blunt differentiation method, and during the follow-up period the progression of neural recovery was assessed. The incidence of neural injury of the inferior alveolar nerve was 42.3%, comminuted and displaced linear fractures were associated with higher incidence of inferior alveolar nerve injury and prolonged recovery time, and recovery of inferior alveolar nerve function occurred in 91%.Fractures of the mandible involving the ramus, angle, and body regions, and comminuted and displaced linear fractures are factors that increase the incidence of inferior alveolar nerve injuries. Missile injuries can be considered as another risk factor.