DOCSLIB.ORG

Risk Assessment of Endodontic-Related Nerve Injuries: Part 2

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Risk Assessment of Endodontic-Related Nerve Injuries: Part 2 CONTINUING EDUCATION Risk assessment of endodontic-related nerve injuries: part 2 In the final part of two articles, Dr. Tara Renton explores risk assessment, diagnosis, and management of endodontic-related nerve injuries n part 1 of this clinical article, the Iauthor examined the risk factors and Educational aims and objectives consequences of endodontic-related nerve This clinical article aims to consider and assess risk factors associated with increased risk injuries. Here, the author looks at the risk of endodontic-related nerve injury. assessment, diagnosis, and management of endodontic-related nerve injuries, as well Expected outcomes Endodontic Practice US subscribers can answer the CE questions on page XX to as recommendations using the literature. earn 2 hours of CE from reading this article. Correctly answering the questions will demonstrate the reader can: Minimizing risk • Consider and assess risk factors associated with increased risk of nerve injury. Risk assessment of the patient and • Understand the diagnostic features of endodontic-related nerve injuries with particular emphasis on the possible 2- to 3-day delay in presentation after treatment dental factors are very important. Patients • Recognize the urgency with which these nerve injuries must be recognized, assessed, and managed if the over the age of 50 are less likely to recover resolution of nerve injury is too maximized. from nerve injury. Certain medical conditions may predispose your patient to developing chronic post-traumatic neuropathy and/ Table 1: CBCT radiography may assist in risk assessment for nerve injury related to endodontic or pain (existing fibromyalgia, migraines, treatment chemical leakage Raynaud’s disease, IBS, and psychological Predisposing tooth factor that may result in an adverse Potential adverse incident if tooth factor not recognized morbidity). Pre-screening of dental neuro- incident during root canal treatment pathic pain is advised before undertaking Resorption defects where extent is not identified such Extrusion of endodontic filler/hypochlorite accident repeated endodontics or further interven- as internal/external communicating with root canal and external surface of the root tional surgery. A key factor in these cases appears Suspicion of a perforation communicating with the Extrusion of endodontic filler/hypochlorite accident to be proximity of the tooth apex to the external root surface inferior dental canal (IDC). The mandibular Root fracture where there could be a potential commu- Extrusion of endodontic filler/hypochlorite accident premolars located close to the mental nication of the root canal with external root surface foramina are considered high risk in ortho- Sclerosed root canal Possible perforation with subsequent hypochlorite accident dontics for potential nerve damage (Knowles, Dens invaginatus Possible perforation with subsequent hypochlorite accident Jergenson, Howard, 2003; Baxmann, 2006; Scarano, et al., 2007). Periapical lesions and other pathology (cysts) Neurological injury (may occur if lesion close to inferior dental canal) An important factor often overlooked in endodontics is the “safety zone,” often Lower molar teeth where root apices are in close prox- Neurological injury (over-instrumentation, overfilling with referred to during estimation of drilling imity to the inferior dental canal and/or mental foramen obturation materials or sealer) depths for implant preparation surgery. A single paper addresses the notion that endo- apical leakage or over-instrumentation will the actual position of the IDC, mental loop, dontists should consider the distance more likely cause nerve injury if the apex is and accessory canals can be complex, and between the tooth apex and the inferior adjacent to the IDC (Ngeow, 2010). the clinician involved in treatment planning dental canal (IDC estimated on a plain film Assessment of other dental factors, must be able to analyze and risk-assess not necessarily by a cone beam computed including root fractures and periapical lesions radiological investigations and not leave the tomography [CBCT]) to ensure that accidental (Table 1) must also be assessed. Assessing risk assessment to another clinician. There continues to be considerable debate as to whether CBCT is superior in assessing these Tara Renton, BDS, MDSc, PhD, FDS, RCS, FRACDS (OMS), FHEA, is a specialist in oral surgery with a particular interest in risk factors. trigeminal nerve injuries and pain. After completing her oral and maxillofacial surgical training in Melbourne in 1991, Dr. Renton undertook a PhD in trigeminal nerve injury at King’s College London in 1999. She was later appointed senior lecturer at Queen Mary University of London and was then awarded her chair in 2006 at King’s College London. Over the past 7 years, Dr. Renton Minimizing technical causes has led the teaching of dental students, modernizing the oral surgical teaching with minimal access approach and modern local Apical extrusion of products may be anesthesia techniques. She has established an academic training program, and in collaboration with the Institute of Psychiatry, increased by ultrasonics and minimized by Psychology & Neuroscience at King’s College London and Imperial College, Dr. Renton has established an international program of trigeminal nerve injury and orofacial pain research. using EndoVac. Postoperative root canal treatment views must be arranged on the day 26 Endodontic practice Volume 10 Number 1 CONTINUING EDUCATION Figure 1: Abducent and inferior alveolar nerve injury due to endodontic overfill of mandibular molar (image courtesy of S. Ruggiero) of completion of the treatment, and identifi- cation of any root canal treatment product in Figure 2: Panoral X-ray illustrating overfill and leakage of endodontic material into inferior dental canal the inferior alveolar nerve (IAN) canal should be reviewed carefully and removed within 48 • In contrast, the apex of each second the clinician must carry out a complete hours (Helvacıog˘lu Kivanç, 2015). A system- premolar was between 0 mm and medical history, panoramic and periapical atic review made a specific recommendation 4.7 mm from the respective mental radiography, and (in some cases) computed in care when preventing extrusion of endo foramen in various cadaveric studies tomography, as well as mechanoreceptive materials into the IDC (Olsen, et al., 2014). (Denio, Torabinejad, Bakland, 1992). and nociceptive tests. CBCT guidance It is important to recognize that inferior Is CBCT better than long cone periapical alveolar nerve injuries (IANI) can occur due All radiographic examinations must be radiographs (LCPA) for risk assessment? to local anesthetic block injections, and the justified on an individual needs basis whereby Periapical pathology diagnosis using clinician can often discriminate between the benefits to the patient of each exposure CBCT revealed a significantly lower number endodontic and local anesthesia-caused must outweigh the risks. In no case may the of favorable outcomes than periapicals in nerve injuries by careful questioning and exposure of patients to X-rays be consid- root canal retreatment. This significantly clinical neurological assessment. ered “routine,” and certainly CBCT exami- affected the future management of cases Chemical nerve injury may not be obvious nations should not be done without initially attending for a review (Davies, et al., 2015). radiographically: obtaining a thorough medical history and In a study by Chavda and colleagues • If the patient is suffering from clinical examination. CBCT should only be (2014), 21 unsalvageable teeth from 20 neuropathy after the local anes- considered an adjunct to two-dimensional patients that had been radiographed and thetic has worn off and the post- imaging in dentistry (American Association scanned with CBCT imaging were included operative radiographs confirm that of Endodontists, American Academy of Oral to look at root fractures. The teeth were atrau- there is no radiopaque material in the and Maxillofacial Radiology, 2011). matically extracted and visually inspected canal, chemical nerve injury may be under a microscope to confirm the presence/ presumed. Risk assessment — location of the inferior absence of fracture. Both digital radiography • Mapping of the neuropathic area will dental canal and CBCT imaging have significant limita- discriminate between inferior dental • A classic study of the relationship tions when detecting vertical root fractures. between mandibular premolar apices block (IDB) and endodontic nerve injury. and the mental foramen has reported Is dose reduction possible in CBCT? • This may be an irreversible injury close proximity with the first premolar Limited field-of-view CBCT systems can to the nerve and subsequent, even apex in 15.4% of patients and with provide images of several teeth from approxi- swift, removal of the root canal filling the second premolar apex in 13.9% mately the same radiation dose as two peri- or tooth is unlikely to resolve the of patients (Fishel, et al., 1976). apical radiographs, and they may provide a nerve injury. • In their morphometric study, Phillips dose savings over multiple traditional images and colleagues reported that each in complex cases. • If there is material recognized within mental foramen was located an Both 360° and 180° CBCT scans yielded the canal, this would suggest injury, average distance of 2.18 mm mesially similar accuracy in the detection of artificial but if there is no material in the canal, and
Load more

Recommended publications
  • Numb Tongue, Numb Lip, Numb Chin: What to Do When?
    NUMB TONGUE, NUMB LIP, NUMB CHIN: WHAT TO DO WHEN? Ramzey Tursun, DDS, FACS Marshall Green, DDS Andre Ledoux, DMD Arshad Kaleem, DMD, MD Assistant Professor, Associate Fellowship Director of Oral, Head & Neck Oncologic and Microvascular Reconstructive Surgery, DeWitt Daughtry Family Department of Surgery, Division of Oral Maxillofacial Surgery, Leonard M. Miller School of Medicine, University of Miami INTRODUCTION MECHANISM OF NERVE Microneurosurgery of the trigeminal nerve INJURIES has been in the spotlight over the last few years. The introduction of cone-beam When attempting to classify the various scanning, three-dimensional imaging, mechanisms of nerve injury in the magnetic resonance neurography, maxillofacial region, it becomes clear that endoscopic-assisted surgery, and use of the overwhelming majority are iatrogenic allogenic nerve grafts have improved the in nature. The nerves that are most often techniques that can be used for affected in dento-alveolar procedures are assessment and treatment of patients with the branches of the mandibular division of nerve injuries. Injury to the terminal cranial nerve V, i.e., the trigeminal nerve. branches of the trigeminal nerve is a well- The lingual nerve and inferior alveolar known risk associated with a wide range of nerve are most often affected, and third dental and surgical procedures. These molar surgery is the most common cause 1 injuries often heal spontaneously without of injury. medical or surgical intervention. However, they sometimes can cause a variety of None of these nerves provide motor symptoms, including lost or altered innervation. However, damage to these sensation, pain, or a combination of these, nerves can cause a significant loss of and may have an impact on speech, sensation and/or taste in affected patients.
    [Show full text]
  • The Influence of Mandibular Skeletal Characteristics on Inferior Alveolar Nerve Block Anesthesia
    pISSN 2383-9309❚eISSN 2383-9317 Original Article J Dent Anesth Pain Med 2015;15(3):113-119❚http://dx.doi.org/10.17245/jdapm.2015.15.3.113 The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia Tae Min You1, Kee-Deog Kim2, Jisun Huh2, Eun-Jung Woo2, Wonse Park2 1Department of Advanced General Dentistry, College of Dentistry, Dankook University, Cheonan, Korea 2Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea Background: The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics Methods: In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed. Results: The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups. Conclusions: IANB failure could be attributable, in part, to the skeletal characteristics of the mandible.
    [Show full text]
  • Anatomy of Maxillary and Mandibular Local Anesthesia
    Anatomy of Mandibular and Maxillary Local Anesthesia Patricia L. Blanton, Ph.D., D.D.S. Professor Emeritus, Department of Anatomy, Baylor College of Dentistry – TAMUS and Private Practice in Periodontics Dallas, Texas Anatomy of Mandibular and Maxillary Local Anesthesia I. Introduction A. The anatomical basis of local anesthesia 1. Infiltration anesthesia 2. Block or trunk anesthesia II. Review of the Trigeminal Nerve (Cranial n. V) – the major sensory nerve of the head A. Ophthalmic Division 1. Course a. Superior orbital fissure – root of orbit – supraorbital foramen 2. Branches – sensory B. Maxillary Division 1. Course a. Foramen rotundum – pterygopalatine fossa – inferior orbital fissure – floor of orbit – infraorbital 2. Branches - sensory a. Zygomatic nerve b. Pterygopalatine nerves [nasal (nasopalatine), orbital, palatal (greater and lesser palatine), pharyngeal] c. Posterior superior alveolar nerves d. Infraorbital nerve (middle superior alveolar nerve, anterior superior nerve) C. Mandibular Division 1. Course a. Foramen ovale – infratemporal fossa – mandibular foramen, Canal -> mental foramen 2. Branches a. Sensory (1) Long buccal nerve (2) Lingual nerve (3) Inferior alveolar nerve -> mental nerve (4) Auriculotemporal nerve b. Motor (1) Pterygoid nerves (2) Temporal nerves (3) Masseteric nerves (4) Nerve to tensor tympani (5) Nerve to tensor veli palatine (6) Nerve to mylohyoid (7) Nerve to anterior belly of digastric c. Both motor and sensory (1) Mylohyoid nerve III. Usual Routes of innervation A. Maxilla 1. Teeth a. Molars – Posterior superior alveolar nerve b. Premolars – Middle superior alveolar nerve c. Incisors and cuspids – Anterior superior alveolar nerve 2. Gingiva a. Facial/buccal – Superior alveolar nerves b. Palatal – Anterior – Nasopalatine nerve; Posterior – Greater palatine nerves B.
    [Show full text]
  • Communication Between the Mylohyoid and Lingual Nerves: Clinical Implications
    Int. J. Morphol., Case Report 25(3):561-564, 2007. Communication Between the Mylohyoid and Lingual Nerves: Clinical Implications Comunicación entre los Nervios Milohioideo y Lingual: Implicancias Clínicas *Valéria Paula Sassoli Fazan; **Omar Andrade Rodrigues Filho & ***Fernando Matamala FAZAN, V. P. S.; RODRIGUES FILHO, O. A. & MATAMALA, F. Communication between the mylohyoid and lingual nerves: Clinical implications. Int. J. Morphol., 25(3):561-564, 2007. SUMMARY: The mylohyoid muscle plays an important role in chewing, swallowing, respiration and phonation, being the mylohyoid nerve also closely related to these important functions. It has been postulated that the mylohyoid nerve might have a role in the sensory innervation of the chin and the lower incisor teeth while the role of the mylohyoid nerve in the mandibular posterior tooth sensation is still a controversial issue. Although variations in the course of the mylohyoid nerve in relation to the mandible are frequently found on the dissecting room, they have not been satisfactorily described in the anatomical or surgical literature. It is well known that variations on the branching pattern of the mandibular nerve frequently account for the failure to obtain adequate local anesthesia in routine oral and dental procedures and also for the unexpected injury to branches of the nerves during surgery. Also, anatomical variations might be responsible for unexpected and unexplained symptoms after a certain surgical procedure. We describe the presence of a communicating branch between the mylohyoid and lingual nerves in an adult male cadaver, and discuss its clinical/surgical implications as well as its possible role on the sensory innervation of the tongue.
    [Show full text]
  • Inferior Alveolar Nerve Trajectory, Mental Foramen Location and Incidence of Mental Nerve Anterior Loop
    Med Oral Patol Oral Cir Bucal. 2017 Sep 1;22 (5):e630-5. CBCT anatomy of the inferior alveolar nerve Journal section: Oral Surgery doi:10.4317/medoral.21905 Publication Types: Research http://dx.doi.org/doi:10.4317/medoral.21905 Inferior alveolar nerve trajectory, mental foramen location and incidence of mental nerve anterior loop Miguel Velasco-Torres 1, Miguel Padial-Molina 1, Gustavo Avila-Ortiz 2, Raúl García-Delgado 3, Andrés Ca- tena 4, Pablo Galindo-Moreno 1 1 DDS, PhD, Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain 2 DDS, MS, PhD, Department of Periodontics, College of Dentistry, University of Iowa, Iowa City, USA 3 Specialist in Dental and Maxillofacial Radiology. Private Practice. Granada, Spain 4 PhD, Department of Experimental Psychology, School of Psychology, University of Granada, Granada, Spain Correspondence: School of Dentistry, University of Granada 18071 - Granada, Spain [email protected] Velasco-Torres M, Padial-Molina M, Avila-Ortiz G, García-Delgado R, Catena A, Galindo-Moreno P. Inferior alveolar nerve trajectory, mental foramen location and incidence of mental nerve anterior loop. Med Oral Received: 07/03/2017 Accepted: 21/06/2017 Patol Oral Cir Bucal. 2017 Sep 1;22 (5):e630-5. http://www.medicinaoral.com/medoralfree01/v22i5/medoralv22i5p630.pdf Article Number: 21905 http://www.medicinaoral.com/ © Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946 eMail: [email protected] Indexed in: Science Citation Index Expanded Journal Citation Reports Index Medicus, MEDLINE, PubMed Scopus, Embase and Emcare Indice Médico Español Abstract Background: Injury of the inferior alveolar nerve (IAN) is a serious intraoperative complication that may occur during routine surgical procedures, such as dental implant placement or extraction of impacted teeth.
    [Show full text]
  • Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in Relation with Dental Implantology
    JOURNAL OF ORAL & MAXILLOFACIAL RESEARCH Juodzbalys et al. Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in Relation with Dental Implantology Gintaras Juodzbalys1, Hom-Lay Wang2, Gintautas Sabalys1 1Department of Oral and Maxillofacial Surgery, Kaunas University of Medicine, Lithuania 2Department of Periodontics and Oral Medicine, University of Michigan, Ann Arbor Michigan, USA Corresponding Author: Gintaras Juodzbalys Vainiku 12 LT- 46383, Kaunas Lithuania Phone: +370 37 29 70 55 Fax: +370 37 32 31 53 E-mail: [email protected] ABSTRACT Objectives: It is critical to determine the location and configuration of the mandibular canal and related vital structures during the implant treatment. The purpose of the present paper was to review the literature concerning the mandibular canal and inferior alveolar neurovascular bundle anatomical variations related to the implant surgery. Material and Methods: Literature was selected through the search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, inferior alveolar nerve, and inferior alveolar neurovascular bundle. The search was restricted to English language articles, published from 1973 to November 2009. Additionally, a manual search in the major anatomy, dental implant, prosthetic and periodontal journals and books were performed. Results: In total, 46 literature sources were obtained and morphological aspects and variations of the anatomy related to implant treatment in posterior mandible were presented as two entities: intraosseous mandibular canal and associated inferior alveolar neurovascular bundle. Conclusions: A review of morphological aspects and variations of the anatomy related to mandibular canal and mandibular vital structures are very important especially in implant therapy since inferior alveolar neurovascular bundle exists in different locations and possesses many variations.
    [Show full text]
  • Inferior Alveolar Nerve Paresthesia Caused by a Dentigerous Cyst Associated with Three Teeth
    Med Oral Patol Oral Cir Bucal 2007;12:E388-90. Dentigerous cyst associated with three teeth Med Oral Patol Oral Cir Bucal 2007;12:E388-90. Dentigerous cyst associated with three teeth Inferior alveolar nerve paresthesia caused by a dentigerous cyst associated with three teeth Mahmut Sumer 1, Burcu Baş 2, Levent Yıldız 3 (1) Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry (2) Research Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry (3) Associate Professor, Department of Pathology, Faculty of Medicine, University of Ondokuz Mayis, Samsun, Turkey Correspondence: Dr. Burcu Baş Ondokuz Mayis University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, 55139, Kurupelit, Samsun, Turkey E-mail: [email protected] Sumer M, Baş B, Yıldız L. Inferior alveolar nerve paresthesia caused by Received: 29-09-2006 a dentigerous cyst associated with three teeth. Med Oral Patol Oral Cir Accepted: 22-02-2007 Bucal 2007;12:E388-90. © Medicina Oral S. L. C.I.F. B 96689336 - ISSN 1698-6946 Indexed in: -Index Medicus / MEDLINE / PubMed -EMBASE, Excerpta Medica -SCOPUS -Indice Médico Español -IBECS ABSTRACT The dentigerous cyst is a common pathologic entity associated with an impacted tooth, usually third molars. They gen- erally are asymptomatic, being found on routine dental radiographic examination. This report describes the case of a 43 year old male with a large dentigerous cyst associated with mandibular canine, first and second premolar teeth that caused paresthesia of the inferior alveolar nerve. Key words: Dentigerous cyst, inferior alveolar nerve paresthesia, mandible. INTRODUCTION Case report The dentigerous or follicular cysts are the second most A 43-year-old male was referred to the Oral and Maxillo- common type of odontogenic cysts and the most common facial Surgery Clinic with the complaint of a swelling over- developmental cysts of the jaws (1).
    [Show full text]
  • Variants of Inferior Alveolar Nerve Block: a Review 35 Anuradha M, Yashavanth Kumar D.S, Harsha .V
    CODS Journal of Dentistry Ocial Publication of College of Dental Sciences Alumni Association, Davanagere Volume 6, Issue 1, 2014 CONTENTS Director’s Message 1 V.V. Subba Reddy President’s Message 2 Vasundhara Shivanna Secretary’s Message 3 Praveen S. Basandi Editorial 4 Nandini D.B Original Articles Effect of alcohol containing and alcohol free mouth rinses on microhardness of three 5 esthetic restorative materials Vasundhara Shivanna, Rucha Nilegaonkar Prevalence and distribution of dental anomalies and fluorosis in a small cohort of 9 Indian school children and teenagers Selvamani. M , Praveen S Basandi, Madhushankari G.S Review Articles Paperless dentistry - The future 13 Mala Ram Manohar, Gajendra Bhansali Photo activated disinfection in restorative dentistry - A technical review 16 Deepak B.S, Mallikarjun Goud K, Nishanth P An overview of occupational hazards in dental practice and preventive measures. 19 Poorya Naik .D.S, Chetan .S, Gopal Krishna.B.R, Naveen Shamnur An overview on influences of estrogen and progesterone on periodontium 26 Deepa D CODS Journal of Dentistry 2014, Volume 6, Issue 1 CODS Journal of Dentistry Ocial Publication of College of Dental Sciences Alumni Association, Davanagere Volume 6, Issue 1, 2014 CONTENTS Review Articles Dental home - A new approach for child oral health care 30 Poornima P, Meghna Bajaj, Nagaveni N.B, Roopa K.B, V.V. Subba Reddy Variants of inferior alveolar nerve block: A review 35 Anuradha M, Yashavanth Kumar D.S, Harsha .V. Babji, Rahul Seth Case Reports Ellis-van Creveld syndrome affecting siblings: A case report and review 40 Mamatha G.P, Manisha Jadhav , Rajeshwari G Annigeri, Poornima .P, V.V Subba Reddy Integrated approach of ceramic and composite veneers in tetracycline stained teeth: A case report.
    [Show full text]
  • Nerve Evaluation Protocol 2014
    Nerve Evaluation Protocol 2014 TABLE OF CONTENTS INTRODUCTION .................................................................................................... 1 A REVIEW OF SENSORY NERVE INJURY ................................................................ 3 TERMINOLOGY ...................................................................................................... 5 INFORMED CONSENT ............................................................................................ 6 PREOPERATIVE EVALUATION ................................................................................ 7 TESTS FOR SENSORY NERVE FUNCTION: ........................................................... 12 MATERIALS NEEDED FOR TESTING SENSORY PERCEPTION .............................. 17 TESTING TECHNIQUE .......................................................................................... 20 REFERENCES .......................................................................................................... 23 BIBLIOGRAPHY - CORONECTOMY ..................................................................... 28 SAMPLE SENSORY RECORDING SHEETS ............................................................. 30 A HANDOUT FOR PATIENTS ............................................................................... 33 INTRODUCTION The first edition of this document was produced in the Spring of 1988. Dr. A. F. Steunenberg and Dr. M. Anthony Pogrel collaborated to produce the first edition with input from Mr. Art Curley, Esquire, and with Dr. Charles Alling editing
    [Show full text]
  • Neuromodulation of the Lingual Nerve: a Novel Technique
    CASE REPORT J Neurosurg 134:1271–1275, 2021 Neuromodulation of the lingual nerve: a novel technique Christopher E. Talbot, DO,1,2 Kevin Zhao, DO,1,2 Max Ward, BS,2 Aron Kandinov, MD,2,3 Antonios Mammis, MD,1,2 and Boris Paskhover, MD2,3 Departments of 1Neurological Surgery and 3Otolaryngology–Head & Neck Surgery, 2Rutgers New Jersey Medical School, Newark, New Jersey Acute injury of the trigeminal nerve or its branches can result in posttraumatic trigeminal neuropathy (PTTN). Affected patients suffer from chronic debilitating symptoms long after they have recovered from the inciting trauma. Symptoms vary but usually consist of paresthesia, allodynia, dysesthesia, hyperalgesia, or a combination of these symptoms. PTTN of the trigeminal nerve can result from a variety of traumas, including iatrogenic injury from various dental and maxillofa- cial procedures. Treatments include medications, pulsed radiofrequency modulation, and microsurgical repair. Although trigeminal nerve stimulation has been reported for trigeminal neuropathy, V3 implantation is often avoided because of an elevated migration risk secondary to mandibular motion, and lingual nerve implantation has not been documented. Here, the authors report on a patient who suffered from refractory PTTN despite multiple alternative treatments. He elected to undergo novel placement of a lingual nerve stimulator for neuromodulation therapy. To the best of the authors’ knowl- edge, this is the first documented case of lingual nerve stimulator implantation for lingual neuropathy, a technique for potentially reducing the risk of electrode migration. https://thejns.org/doi/abs/10.3171/2020.2.JNS193109 KEYWORDS neuromodulation; lingual; trigeminal; stimulation; burning mouth; face pain; surgical technique; peripheral nerve CUTE injury of the trigeminal nerve or its branches ing speech or eating.2 Thus, obtaining adequate symptom can result in posttraumatic trigeminal neuropathy relief in these patients is of the utmost importance in im- (PTTN), sometimes referred to as “trigeminal proving their quality of life.
    [Show full text]
  • A Review of the Mandibular and Maxillary Nerve Supplies and Their Clinical Relevance
    AOB-2674; No. of Pages 12 a r c h i v e s o f o r a l b i o l o g y x x x ( 2 0 1 1 ) x x x – x x x Available online at www.sciencedirect.com journal homepage: http://www.elsevier.com/locate/aob Review A review of the mandibular and maxillary nerve supplies and their clinical relevance L.F. Rodella *, B. Buffoli, M. Labanca, R. Rezzani Division of Human Anatomy, Department of Biomedical Sciences and Biotechnologies, University of Brescia, V.le Europa 11, 25123 Brescia, Italy a r t i c l e i n f o a b s t r a c t Article history: Mandibular and maxillary nerve supplies are described in most anatomy textbooks. Accepted 20 September 2011 Nevertheless, several anatomical variations can be found and some of them are clinically relevant. Keywords: Several studies have described the anatomical variations of the branching pattern of the trigeminal nerve in great detail. The aim of this review is to collect data from the literature Mandibular nerve and gives a detailed description of the innervation of the mandible and maxilla. Maxillary nerve We carried out a search of studies published in PubMed up to 2011, including clinical, Anatomical variations anatomical and radiological studies. This paper gives an overview of the main anatomical variations of the maxillary and mandibular nerve supplies, describing the anatomical variations that should be considered by the clinicians to understand pathological situations better and to avoid complications associated with anaesthesia and surgical procedures. # 2011 Elsevier Ltd.
    [Show full text]
  • Article Article Topography of the Inferior Alveolar Nerve in Human
    Article Topography of the inferior alveolar nerve in human embryos and fetuses. An histomorphological study. Sergey Lvovich Kabak, 1 Natallia Victorovna Zhuravleva1 & Yuliya Michailovna Melnichenko.1 Affiliations: 1Human Morphology Depart- Abstract: The aim of this study is to establish the position of the inferior ment, Belarusian State Medical University, alveolar nerve in relation to the Meckel’s cartilage, the anlage of the Minsk, Belarus. mandibular body and primordia of the teeth, and also to trace the change in nerve trunk structure in the human prenatal ontogenesis. Serial sections Corresponding author: Yuliya Michailovna (20µm) from thirty-two 6-12 weeks-old entire human embryos and serial Melnichenko. Human Morphology Depart- ment, Belarusian State Medical University, sections (10µm) of six mandibles of 13-20 weeks-old human fetuses without Dzerzhinskogo Avenue 83, Minsk, Belarus. Phone: developmental abnormalities were studied. Histological sections were (375)291637867. Email: [email protected] impregnated with silver nitrate according to Bilshovsky-Buke and stained with hematoxylin and eosin. During embryonic development, the number of branches of the inferior alveolar nerve increases and its fascicular structure Receipt: 10/06/2017 Revised: 10/26/2017 changes. In conclusion, the architecture of intraosseous canals in the body Acceptance: 11/30/2017 Online: 11/30/2017 of the mandible, as well as the location of the foramina, is predetermined by the course and pattern of the vessel/nerve branching in the mandibular arch, even before the formation of bony trabeculae. Particularly, the formation of the incisive canal of the mandible can be explained by the presence of the incisive nerve as the extension of the inferior alveolar nerve.
    [Show full text]