Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery-revisited.
OBJECTIVE
Earlier reports, including a preliminary study within our unit, have shown that the surgeon's experience is one of the most influential factors in determining the likelihood of both permanent inferior alveolar nerve (IAN) and lingual nerve (LN) paresthesia, following third molar surgery. The effect of this and other factors influencing such prevalence are assessed in this study.


METHODS
This prospective study involved 3236 patients who underwent surgical removal of impacted third molars. Patients' demographics and radiological parameters were recorded along with the grade of the treating surgeon. The prevalence of inferior alveolar and lingual nerves paresthesia at 1 month, 6 months, and 18 to 24 months postoperatively were also traced.


RESULTS
At 1 month postoperatively, the incidence of IAN paresthesia was 1.5% and the LN was 1.8%. These figures decreased over time and 18 to 24 months postoperatively, the incidence of permanent dysfunction of the IAN was 0.6% and LN was 1.1%. With regard to inferior alveolar nerve paresthesia, risk factors included the patient's age (26-30 years), horizontally impacted teeth, close radiographic proximity to the inferior alveolar canal (IAC), and treatment by trainee surgeons. With regard to the lingual nerve, risk factors included male patients, distoangular impactions, close radiographic proximity to the IAC, and treatment by trainee surgeons.


CONCLUSIONS
One of the main risk factors of developing permanent sensory dysfunction in the distribution of these nerves is related to the surgical skills/experience of the operator. Other factors are associated with the type of impaction and the radiographic proximity of the tooth to the inferior alveolar nerve. Such long-term complications can affect the patient's quality of life; the impact on profession, education, and research is unknown.
Jerjes
Waseem
W
UCLH Head and Neck Centre, Department of Surgery, University College London Medical School, UCL Eastman Dental Institute, London, UK. waseem_wk1@yahoo.co.uk
Upile
Tahwinder
T
Shah
Priya
P
Nhembe
Farai
F
Gudka
Dipali
D
Kafas
Panagiotis
P
McCarthy
Eileen
E
Abbas
Syedda
S
Patel
Shinali
S
Hamdoon
Zaid
Z
Abiola
Jesuloba
J
Vourvachis
Michael
M
Kalkani
Maria
M
Al-Khawalde
Mohammed
M
Leeson
Rachael
R
Banu
Bilquis
B
Rob
Jubli
J
El-Maaytah
Mohammed
M
Hopper
Colin
C
D000293:Adolescent; D000328:Adult; D020209:Cranial Nerve Injuries / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D061222:Lingual Nerve Injuries; D008131:London / Q000453:epidemiology; D008297:Male; D008334:Mandible; D008964:Molar, Third / Q000601:surgery*; D010292:Paresthesia / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014081:Tooth Extraction / Q000009:adverse effects*; D061221:Trigeminal Nerve Injuries; D055815:Young Adult