Assessment of Lingual Nerve Paresthesia after Removal of Mandibular Third Molar

Surgical removal of impacted mandibular third molars are the most commonly performed minor surgical procedures by maxillofacial surgeon. If not treated can lead to few complications like pericoronitis, root resorption of second molar, caries of second molar, cyst and tumours can arise from them. The common complications include swelling, hematoma, trismus and lingual nerve injuries. In this article 1000 cases of various types impactions were surgically operated and assessment of lingual nerve injury was done.

An Ancient Science to Improve Today’s Clinical Practice: Oral Surgery Meets Human Anatomy

Human body dissection was a ubiquitous practice in the past, to better understand anatomy and to develop medicine. Today, its role could still be important to answer everyday clinical queries and help surgeons. The example of the possible lack of anesthesia during symphysis surgeries can emphasize the usefulness of dissection. The mandibular symphysis usually receives innervation from inferior alveolar nerve terminations, but, in some rare cases, a particular anastomosis involves the lingual nerve and the nerve to the mylohyoid. The anatomical knowledge resulting from body dissections could help oral surgeons to understand the reason why the patient could feel pain during the surgery, and ensure performance of the right lingual nerve block to obtain complete anesthesia. This clinical situation shows the educational role of an ancient, yet still valid, practice, human dissection, and the importance of anatomical studies to improve surgical skills, to provide better treatment for the patient.

Radiographic assessment of impacted mandibular third molars

The surgical remedy of problems related to lower jaw 3 molars is related to common surgical risks like contamination, haemorrhage, pain and swelling. Certain unique risks are related with such surgery, specifically inferior alveolar and lingual nerve harm as these are adjacent vital structures. Risk assessment calls for an entire understanding of dental factors that can impact the care of these characteristic structures. Preoperative radiographic assessment warrants to provide data about the tooth itself, its encompassing bone, the neighbouring dentition, and related anatomical structural systems. Parameters that ought to be assessed are level of impaction, root formulations, angulation of the enamel, number of roots, root morphology, related pathology and, most importantly, the relation some of the crown/roots and the mandibular canal. An appropriate imaging method for 3 molars ought to display the complete 3rd molar and the mandibular canal below it. In this mini review, we elaborate on the generally used radiographic assessment methods of mandibular 3rd molars.

Frequency of Lingual Nerve Damage during Surgical Removal of Impacted 3rd Molar

Introduction: Professional skills, training and experience is mandatory for removing impacted 3rd molars with aid of local/general anesthesia, sedation. As for symptomatic 3rd molars decision for removing is not difficult usually, but for removing asymptomatic 3rd molars decision is less clear & requiring good clinical experience. Objective: The objective this study was to determine frequency of lingual nerve damage during surgical removal of impacted 3rd molar Design: Descriptive cases series Study Setting: This study was conducted at Department of Oral and Maxillofacial Surgery, Sandeman Provincial Hospital Quetta over 6 months (April 10, 2018 till Oct 10, 2018). Materials and Methods: All 149 cases after approval of hospital ethical committee fulfilling the inclusion criteria were included in this study. After clinical and radiographic diagnosis of affected tooth like depth, position or any other difficulty, the surgical procedure was selected. An impacted tooth was labeled when it was failed to explode into the dental arch within the expected developmental window. After operation surgical sites of all patients were reviewed by the same consultant after 7 days. It was instructed to all patients that report any problem in lingual sensation; by clinical examination sensory deficits were recognized bilaterally. Results: The mean age of all cases was 29.82 ± 6.81 years with minimum and maximum age of 18 and 40 years. There were 83(55.7%) male and 66(44.3%) were females. According to types of impaction 22(14.8%) cases had Mesioangular, 10(6.7%) had Horizontal, 12(8.1%) had Vertical, 17(11.4%) had Distoangular, 14(9.4%) had Class I, 15(10.1%) had Class II, 11(7.4%) had Class III, 14(9.4%) had Class A, 16(10.7%) had Class B and 18(12.1%) cases had Class C. A total of 16(10.7%) cases had inguinal injury in this study. Conclusion: This study concludes that 10.7% cases had inguinal injury in this study. So, this procedure of impacted mandibular third molar is associated with minor but expected complications like the lingual nerve damage. Hence, preoperative and intraoperative consideration must be taken up to reduce this preventable complication. Keywords: Impacted teat, 3rd molar, surgery, complications, lingual nerve damage

Preoperative visualization of the lingual nerve by 3D double-echo steady-state MRI in surgical third molar extraction treatment

Objectives To assess the lingual nerve (LN) visualization using a 3D double-echo steady-state MRI sequence (3D-DESS). Materials and methods Three readers prospectively evaluated the LN for its continuous visibility in 3D-DESS MRI in 19 patients with an indication for removal of mandibular impacted third molars, using a 5-point scale (4 = excellent to 0 = none). Six LN anatomical intermediate points (IP) were selected and checked for their detectability by a 4-point scale (4 = yes to1 = no). Inter- and intra-rater agreement was evaluated using intraclass correlation coefficient and percentage of agreement. Results The average nerve continuity score was 3.3 ± 0.46. In 35% of the cases, the entire course was continuously visible. In 10%, the proximal and 60%, the distal part of the nerve was not continuously visible. Inter- and intra-reader agreement was good (ICC = 0.76, ICC = 0.75). The average detectability score of all IP was 3.7 ± 0.41. From IP1 to IP5, the detectability was excellent; meanwhile, IP6 had lower visibility. The inter- and intra-reader percentage of agreement was 77% and 87%. Conclusions The 3D-DESS sequence allowed accurate and continuous visualization of the LN with high reproducibility in more than one-third of the patients. This could improve the preoperative clarification of the LN position and thereby reduce complications during dentoalveolar surgical interventions. Clinical relevance 3D-DESS MRI might be beneficial in clinical scenarios where the second molar is elongated or presents a difficult rotational position while simultaneously having a close positional relationship to the third molar. Thereby, osteotomy performed more lingually, indicating extended lingual flap detachment may increase the risk of LN damage.