title: Factors that are associated with injury to the inferior alveolar nerve in high-risk patients after removal of third molars.
abstract: Our aim was to answer the question: "Among patients at high risk of injury to the inferior alveolar nerve (IAN) after removal of 3rd molars, what factors are associated with postoperative neurosensory deficits?" We organized a retrospective, two-center study and enrolled a group of subjects who were at increased risk of injury to the IAN after removal of 3rd molars because radiographic findings indicated a risk on panoramic radiography that was high enough to warrant preoperative computed tomography (CT). The primary outcome variable was postoperative injury to the IAN. We used descriptive, bivariate, and multivariate analyses to assess the significance of differences, and probabilities of less than 0.05 were accepted as significant. We studied 149 subjects who had 235 3rd molars removed. Their mean (SD) age was 31 (11) years and 25/235 (11%) of 3rd molars were associated with injury to the IAN. In the multiple logistic regression model, increasing age (odds ratio (OR) 1.05, 95% CI 1.01-1.1, p=0.04), female sex (OR 5.3, 95% CI 1.6-16.9, p=0.005), and the size (mm) of the cortical perforation in the inferior alveolar canal (IAC) viewed on the coronal CT cut (OR 1.3; 95% CI 1.0-1.6, p=0.03) were associated with an increased risk of postoperative injury to the IAN. Age, sex, and the size of the perforation in the IAC on the coronal CT were associated with an increased risk of injury to the IAN. These findings may help to guide recommendations for treatment of patients at high risk of injury to the IAN during removal of 3rd molars.
authors.affiliation: Istanbul University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul, Turkey. Electronic address: firatselvi@gmail.com.
authors.forename: Firat
authors.initials: F
authors.lastname: Selvi
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Dodson
authors.forename: Anders
authors.initials: A
authors.lastname: Nattestad
authors.forename: Kevin
authors.initials: K
authors.lastname: Robertson
authors.forename: Len
authors.initials: L
authors.lastname: Tolstunov
mesh_terms: D000328:Adult; D000367:Age Factors; D000539:Alveolar Process / Q000000981:diagnostic imaging; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000294:innervation; D008340:Mandibular Nerve / Q000000981:diagnostic imaging / Q000473:pathology*; D008964:Molar, Third / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications; D011862:Radiography, Panoramic / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D020886:Somatosensory Disorders / Q000209:etiology*; D014081:Tooth Extraction / Q000009:adverse effects*; D014092:Tooth Root / Q000000981:diagnostic imaging; D014095:Tooth, Impacted / Q000000981:diagnostic imaging / Q000601:surgery*; D061221:Trigeminal Nerve Injuries / Q000209:etiology*
keywords: Computed tomography (CT); Cone-beam computed tomography (CBCT); Inferior alveolar nerve (IAN); Mandibular third molar; Nerve injury; Panoramic radiography