Neural complication of third molar Surgeries: Review of management

Adamson, O ; Erinoso, O ; Gbotolorun, O.M. (2020-11)

Article

The surgical extraction of the mandibular third molar is one of the most common procedures performed by the oral and maxillofacial surgeon. it carries a risk of injuries to both the lingula (LN) and the inferior alveolar (IAN). Horizontal impaction is the most implicated in IAN damage while distoangular impaction in LN damage. LN complications occur at a prevalence of 0.1 to 22%, compared to IAN which occurs at 0.26% to 8.4%. Complications to the IAN and LN can result in disturbances presenting as sensory loss, painful sensation, altered taste and speech and ultimately affecting the patient's quality of life Assessment of the nerve injury can be through objective or subjective testing. Objective tests for IAN include two-point discrimination tests, brushstroke direction, light touch test and thermal test. While for LN an objective assessment include the taste stimulation tests. treatment of nerve injuries involves both non surgical and surgical therapy. Non-surgical therapy includes low level laser therapy, acupuncture and adjunct therapies. Adjunct therapies include the use Vitamin B complex, which promotes neural regeneration as wellas sensory re-education therapy, which is a cognitive behavioral technique which can partly compensate foe som of the functional loss associated with nerve injury. Surgical therapies include direct suturing( neurorrhaphy), neurolysis and autogenous graft of nerve. Surgical therapies are the most preferred and optimal result is obtines when done within 3-6 months