Lingual Flap Protection during Third Molar Surgery: A Literature Review

Petroni, Giulia; Passaretti, Alfredo; Zaccheo, F; Nardo, Dario Di; Testarelli, Luca; Cicconetti, Andrea

doi:10.1055/s-0041-1730042

Cited by 5 publications

(3 citation statements)

References 57 publications

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“…A recent review [41] examines how retracting and safeguarding the lingual ap could impact the occurrence of lingual nerve injury (LNI) during third molar extraction, in contrast to protocols not involving manipulation of lingual tissue. In the studies reviewed, the incidence of temporary LNI ranged between 0 and 8.94%, while permanent LNI ranged between 0 and 1.60%.…”

Section: Discussionmentioning

confidence: 99%

A Standardized Step-by-step Technique to Protect Lingual Flap During Third Molar Surgery Avoiding Lingual Nerve Injury: a Retrospective Analysis

Zaccheo,

Petroni,

Gori

et al. 2024

Preprint

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Purpose The aim of this study was to assess a standardized flap technique use in the surgical extraction of the lower third molar, protecting the lingual flap and avoiding lingual nerve injury. Methods A 5 years retrospective analysis of surgical third molar surgery made by third-year oral surgery specialty program students was made in the department of oral surgery of Clinica Odontoiatrica, Policlinico Umberto I in Roma, from 2017 to 2022. All surgery were carried out using a standardized step by step technique to protect the lingual flap during the surgery. Every patient underwent a review on the initial postoperative day and subsequently, one week after the surgery, coinciding with the removal of the sutures. During each postoperative visit, thorough examinations were conducted to assess any sensory nerve impairment of the inferior alveolar, lingual, or mylohyoid nerves. Results None of the cases reported postsurgical lingual nerve injury; there was zero incidence of lingual nerve paresthesia or dysesthesia. There was no increased risk to the lingual nerve paresthesia or dry socket, which were identified. Conclusions This flap proved to be a standardized and reproducible approach for the surgical removal of lower third molars without raising the risk of lingual nerve sensory impairment, regardless of the operator’s experience.

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Section: Discussionmentioning

confidence: 99%

A Standardized Step-by-step Technique to Protect Lingual Flap During Third Molar Surgery Avoiding Lingual Nerve Injury: a Retrospective Analysis

Zaccheo,

Petroni,

Gori

et al. 2024

Preprint

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“…Injury to the IAN and LN during and after MTM surgery can have a variety of causes, including direct trauma to the nerve from rotating instruments during ostectomy or separation, sharp transection during flap preparation, or more indirect damage from compression or chemical disturbance from a hematoma or injection of local anesthetics [ 28 , 29 , 30 , 31 ]. Apart from complete transection of a nerve, which is usually noticed immediately during surgery, it is often difficult to determine the exact cause of nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review

et al. 2022

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Injury to the peripheral branches of the trigeminal nerve, particularly the lingual nerve (LN) and the inferior alveolar nerve (IAN), is a rare but serious complication that can occur during oral and maxillofacial surgery. Mandibular third molar surgery, one of the most common surgical procedures in dentistry, is most often associated with such a nerve injury. Proper preoperative radiologic assessment is hence key to avoiding neurosensory dysfunction. In addition to the well-established conventional X-ray-based imaging modalities, such as panoramic radiography and cone-beam computed tomography, radiation-free magnetic resonance imaging (MRI) with the recently introduced black-bone MRI sequences offers the possibility to simultaneously visualize osseous structures and neural tissue in the oral cavity with high spatial resolution and excellent soft-tissue contrast. Fortunately, most LN and IAN injuries recover spontaneously within six months. However, permanent damage may cause significant loss of quality of life for affected patients. Therefore, therapy should be initiated early in indicated cases, despite the inconsistency in the literature regarding the therapeutic time window. In this report, we present the visualization of two cases of nerve pathology using 3D double-echo steady-state MRI and evaluate evidence-based decision-making for iatrogenic nerve injury regarding a wait-and-see strategy, conservative drug treatment, or surgical re-intervention.

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“…14 On the other hand in a study by Ramadorai and colleagues employed the buccal flaponly technique and found just one case (0.078%) of lingual nerve injury in an audit of 1276 cases of mandibular surgical extractions. 15 In the current study surgical technique employing both buccal and lingual flaps was used for the surgical access of mandibular third molars. The lingual mucoperiosteal flap reflected cleanly and retracted with the blunt end of the molt periosteal elevator which was passively placed to protect the lingual flap.…”

Section: Intact Nervementioning

confidence: 99%

Lingual nerve injury during extraction of mandibular third molars: Are we extracting correctly?

Israr

Asim

Israr³

2023

JSTMU

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Introduction: Neurological injuries including lingual nerve damage are among the most devastating complications of mandibular third molar extraction. Various causes of lingual nerve damage have been proposed in literature including the surgical technique. Objective: This study aims to assess the adverse outcomes of the removal of mandibular third molars in terms of the frequency of lingual nerve injury (LNI). Methodology: This prospective case series was carried out at Maroof International Hospital, Islamabad. Surgical extraction was performed after raising both lingual and buccal mucoperiosteal flaps for surgical access. Ostectomy and tooth sectioning was performed while protecting the lingual flap with a passively placed periosteal elevator. Patients were recalled for the assessment of lingual nerve status, one week postoperatively. Results: Out of the total of 1487 teeth extracted temporary lingual nerve injury was observed in just two cases (0.13%) both of which were extracted because of recurrent pericoronitis. None of the patients had a permanent neurological deficit. Conclusion: For improving civility in nursing college, insight into incivility among students and faculty members is to be developed and policies to be in place to address unacceptable behaviors in a timely and effective manner. A surgical technique using careful lingual flap elevation and passive retraction results in the prevention of iatrogenic lingual nerve injury.

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Lingual Flap Protection during Third Molar Surgery: A Literature Review

Cited by 5 publications

References 57 publications

A Standardized Step-by-step Technique to Protect Lingual Flap During Third Molar Surgery Avoiding Lingual Nerve Injury: a Retrospective Analysis

A Standardized Step-by-step Technique to Protect Lingual Flap During Third Molar Surgery Avoiding Lingual Nerve Injury: a Retrospective Analysis

Visualization of Inferior Alveolar and Lingual Nerve Pathology by 3D Double-Echo Steady-State MRI: Two Case Reports with Literature Review

Lingual nerve injury during extraction of mandibular third molars: Are we extracting correctly?

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