Links between anaesthetic modality and nerve damage during lower third molar surgery

Abstract

Objective To investigate the relationships between eruption status, gender, social class, grade of operator, anaesthetic modality and nerve damage during third molar surgery. Design Two centre prospective longitudinal study. Setting The department of oral and maxillofacial surgery, University Hospital Birmingham NHS Trust and oral surgery outpatient clinics at Birmingham Dental Hospital. Subjects A total of 391 patients had surgical removal of lower third molars. Sensory disturbance was recorded at one week post operatively. Patients with altered sensation were followed up at one month, three months and six months following surgery. Results 614 lower third molars in 391 patients were removed. Fortysix procedures (7.5%) were associated with altered sensation at one week with three procedures (0.49%) showing persistent symptoms at six months. Of these 46 nerve injuries, 26 (4.23%) involved the lingual nerve and 20 (3.25%) the inferior dental nerve (IDN). All three persistent sensations were IDN related. A logistic regression model found that the use of a lingual retractor χ 2 =11.559, p=0.003 was more significant than eruption status χ 2 =12.935, p=0.007. There was no significant relationship between anaesthetic modality, age, social class, sex and seniority of operator. Conclusions There was no link between the choices of local or general anaesthesia and nerve damage during lower third molar removal when difficulty of surgery was taken into account.Third molar surgery may be associated with iatrogenic nerve damage. The incidence of nerve damage following the removal of third molars is well documented. Lingual nerve injury ranges from 0.5%-22% and inferior dental nerve (IDN) injury between 0.5%-7% with a mean of 4%. 1-5 Several factors have been associated with an increased risk of nerve damage; the removal of unerupted teeth, 6 lingual retraction using a narrow instrument

Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases

“…The incidence of permanent sensory disturbance was 0.12% and 0.16% for IAN and LN injury, respectively. These rates are low when compared with incidences of permanent IAN and LN deficit reported in the literature 1,[3][4][5][6][7][8][9][10][11]13,14,[18][19][20][21][22]25,27,[29][30][31]33,[38][39][40][41][42][43]48,49,51,52,57 .…”

Risk Factors for Permanent Injury of Inferior Alveolar and Lingual Nerves During Third Molar Surgery

“…This may explain a higher incidence of permanent injuries under GA than LA in the present study and similar findings have been published previously. 11,33 In contrast, Rehman et al, 34 using logistic regression, found no difference in neurologic injury rate between different forms of anesthesia.…”

Efficacy of low level laser therapy on neurosensory recovery after injury to the inferior alveolar nerve

“…In a recent report by Pogrel and Thamby, more females than males were affected with neuropathic pain [53]. Moreover, other studies which were conducted both in humans and animals indicated that females seem to have more postoperative neurosensory deficit disturbances (especially bilateral sagittal split osteotomy in humans) [20,47,60-64].…”