Perioperative neurosensory changes associated with treatment of mandibular fractures.
OBJECTIVE
The purpose of this study was to document perioperative neurosensory changes in the inferior alveolar nerve (IAN) after mandibular fracture treatment and to identify risk factors associated with these changes.


METHODS
This was a prospective cohort study composed of patients treated for mandibular fractures. The primary study variable was the change between the postinjury/pretreatment IAN neurosensory examination score and the score after fracture reduction. Risk factors were categorized as demographic, anatomic, and treatment. Appropriate descriptive, bivariate, and multivariate statistics were computed.


RESULTS
The cohort was composed of 61 patients with 97 fractured sides. Forty-seven fractures (49%) were located between the lingula and mental foramen, and 50 fractures (51%) were located distal to the mental foramen. Thirty-nine fractures (41%) were displaced by 5 mm or more. Abnormal preoperative IAN neurosensory examinations were documented in 81% of the fractured sides. Fifty-three fractures (54%) were treated by closed reduction and 44 (46%) by open reduction and internal fixation. In 82 fractures (85%), the IAN neurosensory score was unchanged or improved after treatment. In a multivariate model, preoperative neurosensory score, displacement, and treatment were associated with a statistically significant risk (P < or =.05) for postoperative deterioration of IAN sensation.


CONCLUSIONS
Open reduction and internal fixation, fracture displacement of 5 mm or more, and a normal preoperative IAN neurosensory examination were associated with an increased risk for deterioration of the IAN neurosensory score after treatment of mandibular fractures. Additional studies are indicated to determine long-term IAN neurosensory function after mandibular fracture treatment and the factors that affect prognosis.
Halpern
Leslie R
LR
Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. lhalpern1@partners.org
Kaban
Leonard B
LB
Dodson
Thomas B
TB
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005592:Fracture Fixation; D005593:Fracture Fixation, Internal; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008337:Mandibular Fractures / Q000145:classification / Q000601:surgery*; D008340:Mandibular Nerve / Q000503:physiopathology*; D015999:Multivariate Analysis; D017288:Pain Threshold / Q000502:physiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012677:Sensation / Q000502:physiology*; D012678:Sensation Disorders / Q000209:etiology; D012684:Sensory Thresholds / Q000502:physiology; D014110:Touch / Q000502:physiology