J Korean Assoc Oral Maxillofac Surg.  2023 Oct;49(5):262-269. 10.5125/jkaoms.2023.49.5.262.

Middle superior and anterior superior alveolar nerve injury following trauma to the maxillary sinus: a prospective clinico-radiographic evaluation

• Radhakrishna S
• Narayanan E

• KMID: 2547570
• DOI: http://doi.org/10.5125/jkaoms.2023.49.5.262

Abstract

Objectives
Anterior maxillary sinus wall fractures are common in all types of maxillofacial trauma. They can result in various complications, including injury to the surrounding nerves. Owing to its anatomy, trauma to the maxillary antrum can result in injury to the middle superior alveolar nerve (MSAN) and the anterior superior alveolar nerve (ASAN). The purpose of this study is to evaluate neurosensory deficits (NSD) present in maxillary gingiva, incisors, and premolars after injury to the anterior wall of the maxillary antrum.
Materials and Methods
This prospective study was conducted among 39 patients sustaining unilateral fractures of the anterior maxillary sinus wall. Clinical neurosensory tests including two-point discrimination and fine touch discrimination were performed to classify the extent of nerve injuries as mild, moderate, severe, or anesthetic. Additional temperature discrimination and pulpal sensibility tests (electric pulp testing and cold testing) were carried out. A comparison of radiographic fracture patterns and severity of nerve injury was done. Testing was carried out immediately after trauma and at 2-month follow-up.
Results
More than half of the patients assessed in the study group presented with NSD of the teeth and gingiva after trauma. The incidence of deficits varied with the type of test used to measure them. Most frequently, patients presented with both loss of two point as well as fine touch discrimination thresholds. Severe nerve injuries were associated with loss of temperature discrimination clinically and displaced fractures radiographically. There was no significant relationship between the recovery of pulpal and gingival sensation. The patterns of injury and recovery in ASAN and MSAN were similar.
Conclusion
NSD after trauma to the maxillary antrum is relatively common. Clinical loss of temperature discrimination and radiographic signs of fracture lines passing through the canalis sinuosus are predictors of persistent and severe oral NSD.

Keyword

Maxillary sinus; Trigeminal nerve injury,; Oral mucosa; Tooth injuries; Paresthesia

Figure

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  Fig. 1 Computed tomography (CT) and cone-beam CT (CBCT) images of patients with neurosensory deficits. A. Depressed fracture of sinus (arrow). B. Discontinuous fracture (arrow). C. Displaced fracture (arrow). D. CBCT formatted image of the patient with severe neurosensory deficit with fracture line passing through the canine fossa (arrow). E. Three-dimensional reformatted image of the same patient with fracture line (arrow). F. The increase of diameter of the canalis sinuosus (CS) (depicted by white arrow) as compared to the intact CS (depicted by red arrow) in a patient with anaesthesia.

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  Fig. 2 Change in severity of nerve injury to the ASAN (anterior superior alveolar nerve) over two months.

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  Fig. 3 Change in severity of nerve injury for MSAN (middle superior alveolar nerve) over two months.

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  Fig. 4 Fracture patterns in patients with depth of nerve injury.

Reference

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