Myrthel Vranckx1, Hannah Geerinckx2, Hugo Gaêta-Araujo2,3, Andre Ferreira Leite2,4, Constantinus Politis2, Reinhilde Jacobs2,5. 1. OMFS-IMPATH Research Group, , Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7 blok a, 3000, Leuven, Belgium. myrthel.vranckx@outlook.com. 2. OMFS-IMPATH Research Group, , Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7 blok a, 3000, Leuven, Belgium. 3. Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil. 4. Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil. 5. Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
Abstract
OBJECTIVES: The present study aimed to assess whether anatomical variations of the mandibular canal are associated with neurosensory disturbances of the inferior alveolar nerve (IAN) following mandibular third molar removal. METHODS: Two observers compared the detection of third molar root-nerve relations and bifurcations of the mandibular canal on panoramic radiographs and CBCT images of 201 patients undergoing removal of 357 mandibular third molars. Potential neurosensory disturbances of the IAN were surveyed ten days after surgery. Fisher's Exact was performed to correlate presence of canal variations to postoperative neurosensory disturbances. Positive and negative predictive values (PPV, NPV) and likelihood ratios (LR + , LR-) were calculated. RESULTS: Thirteen patients reported postoperative altered sensation of the lower lip, with 2 of them having mandibular canal bifurcations on the ipsilateral side of the injury. Fisher's Exact showed that the studied mandibular canal variations were not related to postoperative neurosensory disturbances. CBCT was superior in visualization of anatomical variations of the mandibular canal. Prevalence of bifurcations was 14% on CBCT and 7% on panoramic radiographs. In both imaging modalities and for all parameters, PPVs were low (0.04 - 0.06) and NPVs were high (0.92 - 0.98), with LR ranging around 1. CONCLUSION: In the present study, the assessed mandibular canal variations had limited predictive value for IAN neurosensory disturbances following third molar removal. CLINICAL RELEVANCE: While a close relation between the third molar and the mandibular canal remains a high risk factor, mandibular canal variations did not pose an increased risk of postoperative IAN injury after third molar removal.
OBJECTIVES: The present study aimed to assess whether anatomical variations of the mandibular canal are associated with neurosensory disturbances of the inferior alveolar nerve (IAN) following mandibular third molar removal. METHODS: Two observers compared the detection of third molar root-nerve relations and bifurcations of the mandibular canal on panoramic radiographs and CBCT images of 201 patients undergoing removal of 357 mandibular third molars. Potential neurosensory disturbances of the IAN were surveyed ten days after surgery. Fisher's Exact was performed to correlate presence of canal variations to postoperative neurosensory disturbances. Positive and negative predictive values (PPV, NPV) and likelihood ratios (LR + , LR-) were calculated. RESULTS: Thirteen patients reported postoperative altered sensation of the lower lip, with 2 of them having mandibular canal bifurcations on the ipsilateral side of the injury. Fisher's Exact showed that the studied mandibular canal variations were not related to postoperative neurosensory disturbances. CBCT was superior in visualization of anatomical variations of the mandibular canal. Prevalence of bifurcations was 14% on CBCT and 7% on panoramic radiographs. In both imaging modalities and for all parameters, PPVs were low (0.04 - 0.06) and NPVs were high (0.92 - 0.98), with LR ranging around 1. CONCLUSION: In the present study, the assessed mandibular canal variations had limited predictive value for IAN neurosensory disturbances following third molar removal. CLINICAL RELEVANCE: While a close relation between the third molar and the mandibular canal remains a high risk factor, mandibular canal variations did not pose an increased risk of postoperative IAN injury after third molar removal.