Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2002
The results of microneurosurgery of the inferior alveolar and lingual nerve.
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Pogrel M Anthony
Аннотация
PURPOSE: The goal was to evaluate the experience of one surgical unit during a 5-year period in the evaluation and management of patients with injuries of the inferior alveolar and lingual nerve with particular reference to indications for and results of microneurosurgery.
PATIENTS AND METHODS: This study includes all patients referred with a diagnosis of injury to the inferior alveolar or lingual nerve during 5-year period from January 1, 1994, to January 1, 1999. All patients were evaluated with Frey's hairs for touch and direction sense, 2-point discrimination, and hot and cold water and Minnesota thermal discs for temperature sensation. Patients who fulfilled certain specified criteria were offered microneurosurgery, and the results were evaluated for those who underwent microneurosurgery.
RESULTS: The study consisted of 880 consecutive patients; 96 were thought to fulfill the criteria for microneurosurgery. Of these, 51 underwent microneurosurgical exploration and repair. In 5 patients, no injury could be detected at surgery, and no corrective surgery was performed other than decompression. In 26 patients, excision and direct anastomosis were performed, and in an additional 20 patients, nerve gap reconstruction was performed. In 16 of these 20 patients, reconstruction was performed with an autogenous vein graft, and in 2 patients, a Gore-Tex tube graft (W.L. Gore & Associates, Inc, Flagstaff, AZ) was used to bridge the nerve gap. In 2 patients, an autogenous nerve was used. Thirty-four of the repairs were made on the lingual nerve, and 17 were made on the inferior alveolar nerve. With the use of established criteria, 10 patients were considered to have had a good improvement in sensation, 18 patients were considered to have had some improvement in sensation, and 22 patients were considered to have had no improvement in sensation; 1 patient reported an increase in dysesthesia after surgery. The semiobjective assessment of patients did not always correspond with the patients' subjective evaluation.
CONCLUSION: In a relatively small study in selected cases, microneurosurgery can provide a reasonable result in improving sensation in the inferior alveolar and lingual nerve. More than 50% of patients experienced some improvement in sensation, and dysesthesia did not develop after surgery in any patient who did not have it before surgery.
PATIENTS AND METHODS: This study includes all patients referred with a diagnosis of injury to the inferior alveolar or lingual nerve during 5-year period from January 1, 1994, to January 1, 1999. All patients were evaluated with Frey's hairs for touch and direction sense, 2-point discrimination, and hot and cold water and Minnesota thermal discs for temperature sensation. Patients who fulfilled certain specified criteria were offered microneurosurgery, and the results were evaluated for those who underwent microneurosurgery.
RESULTS: The study consisted of 880 consecutive patients; 96 were thought to fulfill the criteria for microneurosurgery. Of these, 51 underwent microneurosurgical exploration and repair. In 5 patients, no injury could be detected at surgery, and no corrective surgery was performed other than decompression. In 26 patients, excision and direct anastomosis were performed, and in an additional 20 patients, nerve gap reconstruction was performed. In 16 of these 20 patients, reconstruction was performed with an autogenous vein graft, and in 2 patients, a Gore-Tex tube graft (W.L. Gore & Associates, Inc, Flagstaff, AZ) was used to bridge the nerve gap. In 2 patients, an autogenous nerve was used. Thirty-four of the repairs were made on the lingual nerve, and 17 were made on the inferior alveolar nerve. With the use of established criteria, 10 patients were considered to have had a good improvement in sensation, 18 patients were considered to have had some improvement in sensation, and 22 patients were considered to have had no improvement in sensation; 1 patient reported an increase in dysesthesia after surgery. The semiobjective assessment of patients did not always correspond with the patients' subjective evaluation.
CONCLUSION: In a relatively small study in selected cases, microneurosurgery can provide a reasonable result in improving sensation in the inferior alveolar and lingual nerve. More than 50% of patients experienced some improvement in sensation, and dysesthesia did not develop after surgery in any patient who did not have it before surgery.