J Korean Assoc Oral Maxillofac Surg.  2019 Oct;45(5):233-240. 10.5125/jkaoms.2019.45.5.233.

Management and prevention of third molar surgery-related trigeminal nerve injury: time for a rethink

• Leung YY

• KMID: 2461475
• DOI: http://doi.org/10.5125/jkaoms.2019.45.5.233

Abstract

Trigeminal nerve injury as a consequence of lower third molar surgery is a notorious complication and may affect the patient in long term. Inferior alveolar nerve (IAN) and lingual nerve (LN) injury result in different degree of neurosensory deficit and also other neurological symptoms. The long term effects may include persistent sensory loss, chronic pain and depression. It is crucial to understand the pathophysiology of the nerve injury from lower third molar surgery. Surgery remains the most promising treatment in moderate-to-severe nerve injuries. There are limitations in the current treatment methods and full recovery is not commonly achievable. It is better to prevent nerve injury than to treat with unpredictable results. Coronectomy has been proved to be effective in reducing IAN injury and carries minimal long-term morbidity. New technologies, like the roles of erythropoietin and stem cell therapy, are being investigated for neuroprotection and neural regeneration. Breakthroughs in basic and translational research are required to improve the clinical outcomes of the current treatment modalities of third molar surgery-related nerve injury.

Keyword

Trigeminal nerve injuries; Inferior alveolar nerve; Lingual nerve; Third molar; Postoperative complications

MeSH Terms

Chronic Pain
Depression
Erythropoietin
Humans
Lingual Nerve
Mandibular Nerve
Molar, Third*
Neuroprotection
Postoperative Complications
Regeneration
Stem Cells
Translational Medical Research
Trigeminal Nerve Injuries*
Trigeminal Nerve*
Erythropoietin

Figure

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  Fig. 1 A. A third molar surgery-related lingual nerve injury case presented with anaesthesia, severe hyperaesthesia and dysaesthesia, showing a neuroma-in-continuity upon nerve exploration. B. The traumatic neuroma of a length of 12 mm was excised.

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  Fig. 2 A tension-free lingual nerve reanastomosis with microsutures is the key of successful nerve repair.

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  Fig. 3 Lateralization of the inferior alveolar nerve from the mental foramen allows mobilization of the nerve for reanastomosis.

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