FREQUENCY OF LINGUAL NERVE INJURY IN MANDIBULAR THIRD MOLAR EXTRACTION: A COMPARISON OF TWO SURGICAL TECHNIQUES
AbstractBackground: Surgical removal of impacted mandibular third molar is associated with a number of complications including postoperative bleeding, dry socket, postoperative infection, and injury to regional nerves. Lingual nerve damage is one of the main complications. To prevent this complication different techniques had been used. Lingual flap reflection is one of these procedures in which lingual soft tissue is reflected and retracted deliberately, the nerve is identified and is kept out of the surgical field. The objective of this study was to evaluate a surgical technique for third molar removal which is associated with minimum frequency of lingual nerve damage. Methods: A randomized controlled trial was performed. A total of 380 patients with impacted mandibular third molars were included in this study. Each patient was allotted randomly by blocked randomization to group A where procedure was performed by reflection and retraction of lingual flap in addition to buccal flap and group B where procedure was performed by retraction of buccal flap only. Results: Lingual nerve damage occurred in 8.94% in Group A in which lingual flap retraction was performed but damage was reversible. In group B, 2.63% lingual nerve damage was observed and nature of damage was permanent. The difference was statistically significant (p=0.008). Conclusions: Lingual flap retraction poses 3.4 times increased risk of lingual nerve damage during extraction of mandibular third molar when lingual flap is retracted but the nature of damage is reversible.
Bruce RA, Frederickson GC, Small GS. The age of patients and morbidity associated with third molar surgery. J Am Dent Assoc 1980;101(2):240–5.
Blackburn CW, Bramley PA. Lingual nerve damage associated with removal of lower third molars. Br Dent J 1989;167(3):103–7.
Mason DA. Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 1988;17(5):290–4.
Rood JP. Permanent damage to inferior alveolar and lingual nerve during removal of impacted mandibular third molars. Comparison of two methods of bone removal. Br Dent J 1992;172(3):108–10.
Middlehurst RJ, Baker GR, Rood JP. Postoperative morbidity with mandibular third molar surgery: a comparison of two techniques. J Oral Maxillofac Surg 1988;46(6)474–5.
Pogrel MA, Le H. Etiology of lingual nerve injuries in third molar region: a cadaver and histologic study. J Oral Maxillofac Surg 2006;64(12):1790–4.
Fielding AF, Richiele DP, Frazier G. Lingual nerve paresthesia following third molar surgery: A retrospective clinical stydy. Oral Surg Oral Med Oral Pathol Oral radiol Endod 1997;84(4):345–8.
Pogrel MA, Goldman KE. Lingual flap retraction for third molar removal. J Oral Maxillofac Surg 2004;62(9):1125–30.
Gulicher D, Gerlach KL. Sensory impairment of lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofac Surg 2001;30(4):306–12.
Gomes AC, Vasconcelos BC, de Oliveira e silva ED, de Silva LC. Lingual nerve damage after mandibular third molar surgery: a randomized clinical trial. J Oral Maxillofac Surg 2005;63(10):1443–6.
Gargallo-Albiol J, Buenechea-Imaz R, Gay-Escodo C. Lingual nerve protection during surgical removal of lower third molars. A prospective randomized study. Int J Oral Maxillofac Surg 2000;29(4):268–71.
Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: a West of Scottland oral surgery research group study. Br J Oral Maxilllofac Surg 1992;30(2):78–82.
Rud J. Reevaluation of lingual split bone technique for removal of impacted mandibular third molars. J Oral Maxillofac Surg 1994;42(2):114–7.
Yeh CJ: Simplified split bone technique for removal of impacted third molars. Int J Oral Maxillofac Surg 1995;24(5):348–50.
Pichler JW, Beirne OR. Lingual flap retraction and prevention of lingual nerve damage associated with third molar surgery: a systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91(4):395–401.
Greenwood M, Langton SG, Rood JP. A comparison of broad and narrow retractors for lingual nerve protection during lower third molar surgery. Br J Oral Maxillofac Surg 1994;32(2):114–7.
Walters H. Reducing lingual nerve damage in third molar surgery: A clinical audit of 1350 cases. Br Dent J 1995;178(4):140–4.
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