title: Evidence-based outcomes following inferior alveolar and lingual nerve injury and repair: a systematic review.
abstract: The inferior alveolar nerve (IAN) and lingual (LN) are susceptible to iatrogenic surgical damage. Systematically review recent clinical evidence regarding IAN/LN repair methods and to develop updated guidelines for managing injury. Recent publications on IAN/LN microsurgical repair from Medline, Embase and Cochrane Library databases were screened by title/abstract. Main texts were appraised for exclusion criteria: no treatment performed or results provided, poor/lacking procedural description, cohort <3 patients. Of 366 retrieved papers, 27 were suitable for final analysis. Treatment type for injured IANs/LNs depended on injury type, injury timing, neurosensory disturbances and intra-operative findings. Best functional nerve recovery occurred after direct apposition and suturing if nerve ending gaps were <10 mm; larger gaps required nerve grafting (sural/greater auricular nerve). Timing of microneurosurgical repair after injury remains debated. Most authors recommend surgery when neurosensory deficit shows no improvement 90 days post-diagnosis. Nerve transection diagnosed intra-operatively should be repaired in situ; minor nerve injury repair can be delayed. No consensus exists regarding optimal methods and timing for IAN/LN repair. We suggest a schematic guideline for treating IAN/LN injury, based on the most current evidence. We acknowledge that additional RCTs are required to provide definitive confirmation of optimal treatment approaches.
authors.affiliation: Department of Oral & Maxillofacial Surgery, University of Manchester, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Kushnerev
authors.affiliation: Department of Oral & Maxillofacial Surgery, University of Manchester, Manchester, UK.
authors.forename: J M
authors.initials: JM
authors.lastname: Yates
mesh_terms: D055094:Evidence-Based Dentistry; D006801:Humans; D008036:Lingual Nerve / Q000601:surgery; D061222:Lingual Nerve Injuries / Q000601:surgery; D008340:Mandibular Nerve / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function / Q000502:physiology; D016896:Treatment Outcome; D061221:Trigeminal Nerve Injuries / Q000601:surgery*
keywords: cranial nerve injury; inferior alveolar nerve; lingual nerve; nerve injury; nerve repair; trigeminal neuropathy