Lingual nerve injury (LNI) is a rare, serious complication and previous studies include limited numbers of cases. The aim of this retrospective study was to report the neurosensory outcomes for a large patient cohort with permanent LNI and correlate the mechanism of injury (surgical vs non-surgical) to neurosensory characteristics. Demographics, procedural parameters, mandibular third molar (M3) position, surgeon type, neurosensory test results, and symptoms were recorded for 228 patients and analysed. The majority were female (67.1%). Overall, 59.6% of LNIs were caused by M3 removal and 36.4% by local anaesthesia. Complete loss occurred more frequently in surgical LNIs (P = 0.013). The presence of pain did not differ significantly, however the burning type of pain was significantly more frequent in non-surgical LNIs (P = 0.008) along with altered gustation (P = 0.025). The most common M3 position related to LNI was distoangular (40.4%), class III (63.2%), level A (58.1%) (Winter/Pell and Gregory classifications). The majority of patients undergoing M3 removal were >24 years. A total of 71.7% showed no sign of recovery and 5.5% reported further impairment in their condition. Overall, nine patients underwent microsurgical repair. This study presents neurosensory characteristics potentially decisive for timely referral of operable LNIs.

OBJECTIVE: Our study aims to estimate the prevalence of lingual nerve injury following bilateral sagittal split osteotomy (BSSO).
METHODS: Two reviewers independently conducted a systematic literature search in the Medline and Scopus databases. The pooled prevalence with 95% confidence intervals (CI) was estimated, and quality assessment, outlier analysis, and influential analysis were performed.
RESULTS: In total, eleven eligible studies comprising a total of 1,882 participants were included in this meta-analysis. One study was identified as critically influential. The overall prevalence of lingual sensory impairment was estimated to be as high as 0.1% (95% CI 0.0%-0.6%) with moderate heterogeneity observed between studies.
CONCLUSIONS: It is important for healthcare professionals to be aware of this issue, despite the relatively low rate of lingual nerve deficit after BSSO. Additional research will provide a more comprehensive understanding of the underlying factors contributing to lingual nerve injury, leading to improved preventive measures and treatment strategies. Furthermore, insights gained from future studies will enable healthcare professionals to inform patients about the potential complications and manage their expectations before undergoing BSSO.

OBJECTIVE: This scoping review explores the risk and management of traumatic injuries to the inferior alveolar and lingual nerves during mandibular dental procedures. Emphasizing the significance of diagnostic tools, the review amalgamates existing knowledge to offer a comprehensive overview.
METHODS: A literature search across PubMed, Embase, and Cochrane Library informed the analysis.
RESULTS: Traumatic injuries often lead to hypo-/anesthesia and neuropathic pain, impacting individuals psychologically and socially. Diagnosis involves thorough anamnesis, clinical-neurological evaluations, and radiographic imaging. Severity varies, allowing for conservative or surgical interventions. Immediate action is recommended for reversible causes, while surgical therapies like decompression, readaptation, or reconstruction yield favorable outcomes. Conservative management, utilizing topical anesthesia, capsaicin, and systemic medications (tricyclic antidepressants, antipsychotics, and serotonin-norepinephrine-reuptake-inhibitors), proves effective for neuropathic pain.
CONCLUSIONS: Traumatic nerve injuries, though common in dental surgery, often go unrecorded. Despite lacking a definitive diagnostic gold standard, a meticulous examination of the injury and subsequent impairments is crucial.
CONCLUSIONS: Tailoring treatment to each case\'s characteristics is essential, recognizing the absence of a universal solution. This approach aims to optimize outcomes, restore functionality, and improve the quality of life for affected individuals.

Our primary objective was to assess the efficacy of allogeneic nerve grafts in inferior alveolar nerve or lingual nerve repair. We hypothesized that using allogeneic nerve grafts would be effective, as evidenced by achieving high rates of functional sensory recovery (FSR). Additionally, we looked if sex, time from injury to repair, etiology of nerve damage, and graft length affected outcomes.
A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. PubMed and Scopus databases were searched using specific search strategies to generate eligible studies. Inclusion criteria encompassed studies reporting use of allogeneic grafts, assessing FSR using either Medical Research Council Scale or Neurosensory Testing, and published within the past 15 years.
Across 10 studies conducted between 2011 and 2023, analysis was performed on 149 patients and 151 reconstructed nerves. Allogeneic nerve grafts showed an average FSR rate of 88.0%. Kaplan-Meier analysis of time to FSR postoperatively revealed that of those achieving FSR, 80% achieved it within 6 months and 98% achieved it by 1 year. The mean graft length was 29.92 mm ± 17.94 mm. The most common etiology for nerve damage was third molar extractions (23.3%). Sex distribution among patients revealed that 85 were female (57.0%) and 64 were male (43.0%).
Our primary hypothesis was supported as nerve allografts achieved high rates of FSR. FSR was achieved in normative timeframes, which is 6 to 12 months postoperatively. Furthermore, allografts reduced the risk of posttraumatic trigeminal neuropathy. Time from injury to repair, graft length, etiology of nerve damage, and sex did not affect FSR. As the assessed variables in our study did not affect outcomes, there needs to be a more nuanced approach to understanding and addressing various factors influencing sensory recovery.

OBJECTIVE: MR neurography has the ability to detect and depict peripheral nerve injuries. This study evaluated the potential of MR neurography in the diagnosis of post-traumatic trigeminal neuropathy.
METHODS: Forty-one participants prospectively underwent MR neurography of the lingual and inferior alveolar nerves using a 3D TSE STIR black-blood sequence. Two blinded and independent observers recorded the following information for each nerve of interest: presence of injury, nerve thickness, nerve signal intensity, MR neurography Sunderland class, and signal gap. Afterwards, the apparent nerve-muscle contrast-to-noise ratio and apparent signal-to-noise ratio were calculated. Clinical data (neurosensory testing score and clinical Sunderland class) was extracted retrospectively from the medical records of patients diagnosed with post-traumatic trigeminal neuropathy.
RESULTS: Compared to neurosensory testing, MR neurography had a sensitivity of 38.2% and specificity of 93.5% detecting nerve injuries. When differentiated according to clinical Sunderland class, sensitivity was 19.1% in the presence of a low class injury (I to III) and improved to 83.3% in the presence of a high class (IV to V). Specificity remained unchanged. The area under the curve using the apparent nerve-muscle contrast-to-noise ratio, apparent signal-to-noise ratio, and nerve thickness to predict the presence of an injury was 0.78 (p < .05). Signal intensities and nerve diameter increased in injured nerves (p < .05). Clinical and MR neurography Sunderland scores positively correlated (correlation coefficient = 0.53; p = .005).
CONCLUSIONS: This study shows that MR neurography can accurately differentiate between injured and healthy nerves, especially in the presence of a more severe nerve injury.
CONCLUSIONS: MR neurography is not only able to detect trigeminal nerve injuries, but it can also provide information about the anatomical specifications of the injury, which is not possible with clinical neurosensory testing. This makes MR neurography an added value in the management of post-traumatic trigeminal neuropathy.
CONCLUSIONS: • The current diagnosis of post-traumatic trigeminal neuropathy is mainly based on clinical examination. • MR neurography is able to visualize and stratify peripheral trigeminal nerve injuries. • MR neurography contributes to the diagnostic process as well as to further decision-making.

UNASSIGNED: Lingual nerve injury is a known complication of mandibular third molar (M3M) surgery, and retraction of the lingual flap is reported to reduce the incidence of this complication. However, there is no global consensus on the routine retraction of lingual flap.
UNASSIGNED: The aim of the study was to assess the perception and practice of lingual flap retraction amongst oral and maxillofacial surgeons in Nigeria.
UNASSIGNED: This cross-sectional national survey was conducted amongst 122 oral and maxillofacial surgeons in Nigeria from January 2023 to March 2023 using a validated, structured, self-administered questionnaire. The questionnaire had three sections and 14-item questions. Section A consists of the sociodemographic questions, Section B comprises questions on perception towards lingual flap retraction, whereas Section C consists of questions on the practice of lingual flap retraction. These questionnaires were deployed as an online survey and as hard copies. Both qualitative and quantitative data were analysed. A critical probability level (P < 0.05) was used as the cut-off level for statistical significance.
UNASSIGNED: Most of the participants (47.6%) belong to the age group of 31-40 years. The male-to-female ratio was 6:1. Only 12 (9.8%) participants had a positive perception towards routine lingual flap retractions following M3M surgery. Perception of lingual flap retraction was found not to be associated with the demographic variables of the participants (P > 0.05). A total of 95 participants (77.9%) did not raise nor retract the lingual flap during lower third molar surgery. The rate of practice of lingual flap retraction during third molar surgery was not influenced by any of the factors studied (P > 0.05).
UNASSIGNED: The majority of oral and maxillofacial surgeons in Nigeria do not agree that routine retraction of the lingual flap is necessary to reduce lingual nerve injury and majority, too, do not practice this in their management of impacted lower third molar.

The purpose of this study was to measure and compare coronectomy versus extraction in patients at increased risk for inferior alveolar nerve (IAN) injuries associated with third molar removal in terms of IAN injury and other complications.
The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist. We conducted a comprehensive literature search across six databases and the gray literature from July 15 to August 01, 2022. We employed Rayyan software to identify and remove duplicate articles to ensure data integrity. Our research followed the strategy patient (P), intervention (I), comparison (C), outcome (O), and study (S): (P) patients needing lower third molar surgery at higher risk of IAN injury; (I) surgery options, coronectomy or complete extraction; (C) comparisons included reduced risks of nerve injuries, postoperative complications (pain, infection, alveolitis), and increased risks of reoperation, root migration, and extraction; (O) desired outcomes were preventing nerve injuries and reducing other surgical complications; and (S) observational study designs (cohort, case-control). Excluded from consideration were studies involving teeth other than lower third molars, as well as reviews, letters, conference summaries, and personal opinions. To gauge the certainty of evidence, we employed the Grading of Recommendation, Assessment, Development, and Evaluation instrument, selecting the most current papers with the highest levels of evidence for inclusion. The primary outcome variable of our study centered on evaluating the incidence of IAN injury, and secondly, the lingual nerve (LN) injury, the postoperative pain, infection, localized alveolitis, the necessity for surgical reintervention, root migration, and extraction. These assessments were carried out with respect to their chosen operative technique for managing third molars, either coronectomy or extraction, as predictor variables. We also considered covariates such as age, gender, and the presence of systemic diseases in our analysis to account for potential confounding factors. The pooled data underwent rigorous analysis utilizing an inverse variance method with both random and fixed effect models by the \"metabin\" function in the R program\'s meta-package. Additionally, we assessed the risk of bias in the selected studies by utilizing the Joanna Briggs Institute\'s Critical Appraisal Checklist for Studies Reporting Prevalence Data and the Critical Appraisal Checklist for Case Reports.
Of the 1,017 articles found, after applying the inclusion and exclusion criteria, 42 were included in this study (29 cohort and 13 case-control studies), including 3,095 patients from 18 countries. The meta-analysis showed that coronectomy reduced the risk of IAN injury [OR (Odds Ratio): 0.14; 95% CI (confidence intervals): 0.06-0.30; I2 (inconsistency index) = 0%; P = .0001], postoperative pain (OR: 0.97; 95% CI: 0.33-2.86; I2 = 81%; P = .01), and alveolitis (OR: 0.38; 95% CI: 0.13-1.09; I2 = 32.2%; P = .01) when compared to complete tooth extraction. However, it also highlighted a greater risk of reintervention (OR: 5.38; 95% CI: 1.14-25.28; I2 = 0.0%; P = .01).
This study has demonstrated that coronectomy is associated with a decreased risk for IAN injury and decreased pain and localized alveolitis when compared to complete tooth extraction. However, it is essential to acknowledge the higher likelihood of requiring reintervention with coronectomy. Therefore, clinicians should carefully consider the advantages and potential drawbacks of both techniques and tailor their choices to the unique clinical circumstances of each patient.

暂无摘要。

UNASSIGNED: Understanding the lingual nerve\'s precise location is crucial to prevent iatrogenic injury. This systematic review seeks to determine the lingual nerve\'s most probable topographical location in the posterior mandible.
UNASSIGNED: Two electronic databases were searched, identifying studies reporting the lingual nerve\'s position in the posterior mandible. Anatomical data in the vertical and horizontal dimensions at the retromolar and molar regions were collected for meta-analyses.
UNASSIGNED: Of the 2,700 unique records identified, 18 studies were included in this review. In the vertical plane, 8.8% (95% confidence interval [CI], 1.0%-21.7%) and 6.3% (95% CI, 1.9%-12.5%) of the lingual nerves coursed above the alveolar crest at the retromolar and third molar regions. The mean vertical distance between the nerve and the alveolar crest ranged from 12.10 to 4.32 mm at the first to third molar regions. In the horizontal plane, 19.9% (95% CI, 0.0%-62.7%) and 35.2% (95% CI, 13.0%-61.1%) of the lingual nerves were in contact with the lingual plate at the retromolar and third molar regions.
UNASSIGNED: This systematic review mapped out the anatomical location of the lingual nerve in the posterior mandible, highlighting regions that warrant additional caution during surgeries to avoid iatrogenic lingual nerve injuries.

OBJECTIVE: To determine the frequency of lingual nerve injury (LNI) during the surgical removal of mandibular third molar and the associated risk factors.
METHODS: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, from January to June 2021.
METHODS: A total of 121 patients were included in this study who had undergone impacted third molar surgery. Data were collected on a proforma via interview. Patients were followed up after 1 week, 1 month, and 3 months of duration. Frequency of LNI and its association with various surgical procedure steps were determined.
RESULTS: This study shows that out of 121 patients, frequency of LNI was found to be 3.3% (n=4). The type of impaction (p=0.047), lingual flap retraction (p<0.001), tooth splitting (p=0.029), and longer duration of surgery were found to be significantly associated with it.
CONCLUSIONS: The frequency of LNI during mandibular impacted third molar surgery was 3.3% in this study, and significantly associated with horizontal impaction, lingual flap retraction, tooth splitting, and duration of surgery longer than 30 minutes.
BACKGROUND: Lingual nerve injury, Tooth, Impaction, Third molar, Lingual flap retraction, Tooth splitting.