Clinical Paper
Oral Surgery
Evaluation of trigeminal nerve injuries in relation to third molar surgery in a prospective patient cohort. Recommendations for prevention

https://doi.org/10.1016/j.ijom.2012.06.025Get rights and content

Abstract

Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. This study reports the signs and symptoms that are the features of trigeminal nerve injuries caused by mandibular third molar (M3M) surgery. 120 patients with nerve injury following M3M surgery were assessed. All data were analysed using the SPSS statistical programme and Microsoft Excel. 53 (44.2%) inferior alveolar nerve (IAN) injury cases and 67 (55.8%) lingual nerve injury (LNI) cases were caused by third molar surgery (TMS). Neuropathy was demonstrable in all patients with varying degrees of paraesthesia, dysaesthesia (in the form of burning pain), allodynia and hyperalgesia. Pain was one of the presenting signs and symptoms in 70% of all cases. Significantly more females had IAN injuries and LNIs (p < 0.05). The mean ages of the two groups of patients were similar. Speech and eating were significantly more problematic for patients with LNIs. In conclusion, chronic pain is often a symptom after TMS-related nerve injury, resulting in significant functional problems. Better dissemination of good practice in TMS will significantly minimize these complex nerve injuries and prevent unnecessary suffering.

Section snippets

Methods

The records of 254 patients with trigeminal nerve injuries collected over 3 years, were consulted at the Dental Institute in King's College Hospital, London. Within this cohort, 38 patients presented with trigeminal neuropathy caused by neurological disease, malignancy, multiple sclerosis, sickle cell disease, known alcoholism, injury caused by non-dental trauma, orthognathic surgery, diabetes, HIV, post-herpetic neuralgia, stroke and patients taking chemotherapy. This study evaluated the

Results

This study evaluates 120 patients who presented with trigeminal nerve injury related to TMS, of whom 67 (55.8%) presented with LNI and 53 (44.2%) with IANI. The majority of these injuries were caused by TMS carried out under local anaesthesia (LA, 34 IANI cases and 36 LNI cases), followed by TMS under general anaesthesia (GA, 9 IANI cases and 22 LNI cases). In one case, IANI was caused when a lower 7 was removed in addition to TMS. Significantly more females had IANI and LNI (p < 0.05) and the

Discussion

The removal of wisdom teeth is amongst the most frequently practiced procedures by dentists world wide. In the UK, approximately 300,000 patients undergo M3M removal every year in the national health service, mainly under LA. A large proportion of this patient group presenting with nerve injuries had surgery under GA. Significantly larger neuropathic areas (80%) resulted from TMS carried out under GA in comparison to TMS carried out under LA. This may reflect the increased difficulty of the

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

References (41)

Cited by (0)

View full text