Long-Term Outcome of Trigeminal Nerve Injuries Related to Dental Treatment

Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, CA 94143-0440, USA.
Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons (Impact Factor: 1.43). 05/2011; 69(9):2284-8. DOI: 10.1016/j.joms.2011.02.023
Source: PubMed


There is little information available on the long-term effects on patients of permanent involvement of the inferior alveolar or lingual nerve because of dental treatment. This study has attempted to document this information from patients who were reviewed between 3 and 9 years after injury.
All patients with an ICD-9 diagnosis of 951.2 (injury to the trigeminal nerve) because of dental treatment, seen in the Oral and Maxillofacial Surgery Clinic at the University of California, San Francisco between January 1, 2001 and December 31, 2006, were contacted in an attempt to complete a telephone survey of long-term effects.
Of the 727 patients who were eligible for the study, 145 patients (95 female and 50 male) completed the telephone surveys. Many patients had sought both conventional and alternative treatments after consultation at University of California, San Francisco. A small number of patients had undergone subsequent surgery elsewhere. Many patients reported significant life changes, including adverse effects on employment (13%), relationship changes (14%), depression (37%), problems speaking (38%), and problems eating (43%). In general, however, patients reported improvement over time, often using a number of different coping mechanisms. Males had a greater decrease in symptoms than females, and those older than 40 years reported more pain in the long term than those under 40. Lingual nerve symptoms improved more than inferior alveolar nerve symptoms.
Although most patients continue to have long-term problems that affect the overall quality of life, for most patients there has been improvement in symptoms over time.

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    • "However , the latter are more severe than those of the IAN [27]. Pogrel et al. [22] suggest the possibility of a greater recovery from NDI because it contains a channel that acts as a guide. Cheung et al. [2] found no association between the pattern of inclusion and the incidence of sensory deficit in LN (not in the IAN). "
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    ABSTRACT: Objective: Oral nerve injuries are a less frequent complication but they involve a decrease in the patient life quality. The purpose of the current review is to know the described risk factors to prevent injuries and to know the therapies against an established injury. Materials and methods: A Pubmed search of the English and Spanish language literature from 2000-2012 using the keywords 'oral surgery' or 'trigeminal nerve injuries' or 'lingual nerve injuries' or 'mandibular nerve injuries' was performed. Review articles were included and important articles from the references were added. Results: A total of 662 were obtained from the search, from which 25 were selected accomplishing the inclusion criteria. Moreover, seven important articles were selected from the references of the ones mentioned, obtaining a total of 32 articles for the review. Conclusions: There is a relationship between the position of the extracted tooth and the incidence of the inferior alveolar nerve and lingual nerve injuries; as well as the age of the patient, the intra-operatory exposition of the nerve, the technique access for the lower third molar extraction and the surgeon's inexperience. The radiological examination is useful to evaluate the nerve damage and to decide on the surgical technique.
    Full-text · Article · Jul 2013 · Acta odontologica Scandinavica
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    • "The inferior alveolar nerve (IAN), a branch of the third division of the trigeminal nerve, is occasionally injured during dental surgery such as impacted tooth extraction or dental-implant implantation [22]. IAN injury often causes persistent numbness or pain that can spread to adjacent orofacial regions [12] [13] [17]. "
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    ABSTRACT: Chronic pain often develops in the orofacial region after inferior alveolar nerve (IAN) injury. In animal models IAN injury often causes severe neuropathic pain-like behavior in the IAN-innervated region as well as the adjacent region that includes the whisker pad skin. However, the basis for the spreading of pain to adjacent facial areas after IAN injury is still unknown. In this study we determined if the transient receptor potential vanilloid 1 (TRPV1) was associated with altered nocifensive behavior evoked by stimulation of the whisker pad skin following IAN transection. Grooming behavior after capsaicin injection into the whisker pad region was significantly increased after IAN transection and the increase in the behavior was reversed by systemic administration of a TRPV1 antagonist. The number of phosphorylated extracellular signal-regulated kinase immunoreactive (IR) neurons in trigeminal spinal subnucleus caudalis and upper cervical spinal cord following capsaicin injection into the whisker pad region was significantly greater in IAN-transected rats than sham-operated rats. The number of TRPV1-IR trigeminal ganglion (TG) neurons innervating the whisker pad skin was also increased significantly after IAN transection. The present findings suggest that an increase in TRPV1 expression in TG neurons innervating the whisker pad skin after IAN transection may underlie the spreading of pain to the adjacent whisker pad skin.
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  • No preview · Article · Dec 2011 · Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons
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