G Hägler1, R H Reich. 1. Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universität Bonn. haegler@uni-bonn.de
Abstract
BACKGROUND: Disturbance of lingual nerve function is one of the relevant complications after surgical removal of lower third molars. In the literature, however, protective measures against this complication are not unanimously recommended. In order to find out the current opinion in terms of the state of the art in this field, a questionnaire was sent to the heads of 39 University Departments for Oral and Maxillofacial Surgery in Germany, Austria, and Switzerland. All of them responded. TECHNICAL FINDINGS: In 54% of the departments, a periosteal elevator or similar instrument is recommended for the protection of the lingual nerve in every instance, whereas in 8% of the departments this is not recommended. In the remaining departments, the decision about protective measures is made according to the individual anatomical situation. STATISTICS AND DISCUSSION: The literature review revealed insufficient data quality for a sound data-based decision on whether and when to use an instrument to protect the lingual nerve. In any case, the statistical risk of a temporary disturbance of the lingual nerve seems to be higher with use of the lingual split (0.5%-19.8%) than with the lateral osteomtomy technique (0%-1.9%). In contrast to widespread opinion, even in anatomically difficult cases, there seems to be no statistical advantage of the standardized use of a protective instrument either in respect to temporary or permanent nerve damage. Yet, a slight increase of temporary lesions seems to be documented when the instrument is used. According to the current literature data, the subperiosteal insertion of an instrument to protect the lingual nerve cannot be considered an essential standard procedure in each case.
BACKGROUND: Disturbance of lingual nerve function is one of the relevant complications after surgical removal of lower third molars. In the literature, however, protective measures against this complication are not unanimously recommended. In order to find out the current opinion in terms of the state of the art in this field, a questionnaire was sent to the heads of 39 University Departments for Oral and Maxillofacial Surgery in Germany, Austria, and Switzerland. All of them responded. TECHNICAL FINDINGS: In 54% of the departments, a periosteal elevator or similar instrument is recommended for the protection of the lingual nerve in every instance, whereas in 8% of the departments this is not recommended. In the remaining departments, the decision about protective measures is made according to the individual anatomical situation. STATISTICS AND DISCUSSION: The literature review revealed insufficient data quality for a sound data-based decision on whether and when to use an instrument to protect the lingual nerve. In any case, the statistical risk of a temporary disturbance of the lingual nerve seems to be higher with use of the lingual split (0.5%-19.8%) than with the lateral osteomtomy technique (0%-1.9%). In contrast to widespread opinion, even in anatomically difficult cases, there seems to be no statistical advantage of the standardized use of a protective instrument either in respect to temporary or permanent nerve damage. Yet, a slight increase of temporary lesions seems to be documented when the instrument is used. According to the current literature data, the subperiosteal insertion of an instrument to protect the lingual nerve cannot be considered an essential standard procedure in each case.
Authors: M Kunkel; J Becker; P Boehme; P Engel; G Göz; D Haessler; D Heidemann; E Hellwig; I Kopp; B Kreusser; H-Ch Lauer; H Luckey; E Reinhard; P Schopf; R Singer; H Terheyden; J C Türp; M Weber; D Weingart; R Werkmeister; W Wagner Journal: Mund Kiefer Gesichtschir Date: 2006-07