Neurosensory deficits of inferior alveolar nerve following impacted mandibular third molar extraction: comparison of a two stage versus one stage surgical technique

James, O. ; Oyeneyin, A.O. ; Adeyemi, M.O. ; Adeyemo, W.L. (2019-08-21)

14th Annual Conference and Fair, University of Lagos


Background: Surgical extraction of impacted mandibular third molar (3M) may be associated with post-operative complications. Inferior alveolar nerve (IAN) neurosensory deficits in form of paraesthesia of lower lip and gingivae is a common complications which impacts negatively on the quality of life of the patients. Landi et al has proposed two stage surgical extraction as an alternative surgical procedure to reduce this complication. However, few published studies on staged partial coronectomy are only case reports and case series. Aim and Objectives: To compare neurosensory deficits of inferior alveolar nerve following impacted mandibular third molar extraction using either a two stage or one stage surgical technique. Material and methods: This randomized controlled study was conducted at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital (LUTH) Idi Araba, Lagos State, Nigeria between April 2016 and September 2018. Subjects with mesioangular or horizontal impacted 3M with intimate relationship with inferior alveolar canal who met the inclusion criteria were recruited for the study and informed consent obtained. Surgical extraction was done under local anaesthesia using buccal guttering technique. Subjects were divided into 2 groups (one-stage technique and two-stage technique). The subjects were evaluated for the presence of IAN neurosensory deficit and recovery, as well as the relationships of IAN neurosensory deficits with gender, age and type of impaction. Results: A total of 68 subjects who satisfied the inclusion criteria participated in the study with 34 subjects in each group. There were 33 (48.5%) males and 35 (51.5%) females. The age range of participants was 18-57years with a mean age of 28.07 ± 8.37. There was not statistically significant difference in the age and gender distribution between the 2 groups. Neurosensory deficit of IAN was observed in 6 subjects, comprising of 5 (14.7%) in group A and 1 (3.33%) in group B. This difference was not statistically significant (p=0.23). Temporary nerve deficit was observed in 5 cases while permanent nerve deficit was seen in one patient. Similarly, relationships between the incidence of IAN neurosensory deficit and age, gender, type; position; and class of impaction, and the relationship between the proximity of the root with IAN were found not to be related to the neurosensory deficit outcomes age, gender and type of impaction in both groups were not statistically significant. Conclusion: This study shows that two-stage surgical extraction technique of impacted 3M was associated with lower incidence of IAN injury when compared with conventional one stage technique. The difference was however, not statistically significant. Two-stage surgical technique may be a suitable alternative to one stage surgical extraction technique of impacted 3Ms at risk of IAN injury especially when cost of treatment is taken into consideration.