title: Elimination of permanent injuries to the inferior alveolar nerve following surgical intervention of the "high risk" third molar.
abstract: We aimed to find out whether improved preoperative assessment and surgical planning with cone beam computed tomography (CT) could reduce damage to the inferior alveolar nerve when high risk impacted mandibular third molars are extracted. We recorded the presence or absence of postoperative neuropathy after extraction of 200 lower third molars in 185 patients (where cone beam CT had shown contact between the nerve and root) after treatment in the oral surgery department of King's College Hospital. All patients had had cone beam CT of the teeth after panoramic radiography had indicated increased risk of injury to the nerve during extraction. Experienced oral surgeons did all the operations and postoperative reviews. Patients reported temporary alteration of sensation after operation in 12% of teeth but it resolved in all cases and no patient reported permanent loss of sensation. Permanent sensory disturbance in the distribution of the inferior alveolar nerve after third molars have been removed can be eliminated in high risk cases if operations are planned carefully (including cone beam CT), and the procedure is done by a skilled surgeon who has an appreciation of the anatomy of the nerve and roots, and an insight into the mechanical effect of their surgical manipulation. The incidence of permanent neurosensory dysfunction in this study was zero even though all teeth were intimately related to the inferior alveolar canal.
authors.affiliation: Department of Oral Surgery, King's College Dental Hospital, Bessemer Road, Denmark Hill, London SE5 9RS, United Kingdom. gezala.umar@nhs.net
authors.forename: G
authors.initials: G
authors.lastname: Umar
authors.forename: O
authors.initials: O
authors.lastname: Obisesan
authors.forename: C
authors.initials: C
authors.lastname: Bryant
authors.forename: J P
authors.initials: JP
authors.lastname: Rood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008340:Mandibular Nerve / Q000473:pathology*; D008875:Middle Aged; D008964:Molar, Third / Q000000981:diagnostic imaging / Q000294:innervation / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000517:prevention & control*; D011862:Radiography, Panoramic / Q000379:methods; D012307:Risk Factors; D020886:Somatosensory Disorders / Q000517:prevention & control; D013524:Surgical Flaps; D019228:Tooth Crown / Q000601:surgery; D014081:Tooth Extraction / Q000379:methods; D014092:Tooth Root / Q000000981:diagnostic imaging / Q000601:surgery; D014095:Tooth, Impacted / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D020433:Trigeminal Nerve Diseases / Q000517:prevention & control; D061221:Trigeminal Nerve Injuries / Q000517:prevention & control*; D055815:Young Adult