Jerjes Waseem, Upile Tahwinder, Shah Priya, Nhembe Farai, Gudka Dipali, Kafas Panagiotis, McCarthy Eileen, Abbas Syedda, Patel Shinali, Hamdoon Zaid, Abiola Jesuloba, Vourvachis Michael, Kalkani Maria, Al-Khawalde Mohammed, Leeson Rachael, Banu Bilquis, Rob Jubli, El-Maaytah Mohammed, Hopper Colin
UCLH Head and Neck Centre, Department of Surgery, University College London Medical School, UCL Eastman Dental Institute, London, UK.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Mar;109(3):335-45. doi: 10.1016/j.tripleo.2009.10.010. Epub 2010 Jan 22.
Earlier reports, including a preliminary study within our unit, have shown that the surgeon's experience is one of the most influential factors in determining the likelihood of both permanent inferior alveolar nerve (IAN) and lingual nerve (LN) paresthesia, following third molar surgery. The effect of this and other factors influencing such prevalence are assessed in this study.
This prospective study involved 3236 patients who underwent surgical removal of impacted third molars. Patients' demographics and radiological parameters were recorded along with the grade of the treating surgeon. The prevalence of inferior alveolar and lingual nerves paresthesia at 1 month, 6 months, and 18 to 24 months postoperatively were also traced.
At 1 month postoperatively, the incidence of IAN paresthesia was 1.5% and the LN was 1.8%. These figures decreased over time and 18 to 24 months postoperatively, the incidence of permanent dysfunction of the IAN was 0.6% and LN was 1.1%. With regard to inferior alveolar nerve paresthesia, risk factors included the patient's age (26-30 years), horizontally impacted teeth, close radiographic proximity to the inferior alveolar canal (IAC), and treatment by trainee surgeons. With regard to the lingual nerve, risk factors included male patients, distoangular impactions, close radiographic proximity to the IAC, and treatment by trainee surgeons.
One of the main risk factors of developing permanent sensory dysfunction in the distribution of these nerves is related to the surgical skills/experience of the operator. Other factors are associated with the type of impaction and the radiographic proximity of the tooth to the inferior alveolar nerve. Such long-term complications can affect the patient's quality of life; the impact on profession, education, and research is unknown.
早期报告，包括我们科室的一项初步研究，表明外科医生的经验是决定第三磨牙手术后永久性下牙槽神经（IAN）和舌神经（LN）感觉异常可能性的最有影响因素之一。本研究评估了这一因素以及其他影响此类发生率的因素的作用。
这项前瞻性研究纳入了3236例行阻生第三磨牙手术拔除的患者。记录患者的人口统计学和放射学参数以及主刀医生的级别。还追踪了术后1个月、6个月以及18至24个月时下牙槽神经和舌神经感觉异常的发生率。
术后1个月时，IAN感觉异常的发生率为1.5%，LN为1.8%。这些数字随时间下降，术后18至24个月时，IAN永久性功能障碍的发生率为0.6%，LN为1.1%。关于下牙槽神经感觉异常，危险因素包括患者年龄（26 - 30岁）、水平阻生牙、影像学上与下牙槽管（IAC）距离近以及由实习外科医生治疗。关于舌神经，危险因素包括男性患者、远中阻生、影像学上与IAC距离近以及由实习外科医生治疗。
在这些神经分布区域发生永久性感觉功能障碍的主要危险因素之一与手术操作者的技能/经验有关。其他因素与阻生类型以及牙齿与下牙槽神经的影像学距离有关。此类长期并发症会影响患者的生活质量；对职业、教育和研究的影响尚不清楚。
