Akadiri O A, Fasola A O, Arotiba J T
Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, University of Port-Harcourt, PortHarcourt, Rivers State, PMB 1, Port-Harcourt.
Niger J Med. 2009 Oct-Dec;18(4):402-8. doi: 10.4314/njm.v18i4.51252.
The inferioralveolar (IAN), lingual (LN) and long buccal nerves (LBN)are the three terminal branches of the trigeminal nerve which are susceptible to injury during surgical extraction of impacted mandibular third molars. While it is not always possible to accurately predict the patients that will be affected with these complications, understanding and identifying the risk factors may allow the adoption of appropriate technique and expertise for specific cases. We embarked on this study to document the incidence and duration of injury to the inferior alveolar nerve (IAN), lingual nerve (LN) and long buccal nerve (LBN) following the operative removal of impacted mandibular third molars and to identify the associated radiographic and operative risk factors.
Pre- and postoperative neurosensory tests were performed for seventy nine patients who had surgical extraction of unilateral impacted mandibular third molars to determine the incidence and duration of complicating nerve injuries. The risk factors for nerve injury were determined among the radiographic variables and documented operative events.
The incidence reported were 6.6% for IAN, 2.6% for LN and 4.0% for LBN; all but one of the nerve injuries resolved within 2 weeks. Depth of impaction (Pell & Gregory Level C) and linguo-version were the significant risk factors for IAN and LN injuries respectively while no risk factors was detected for LBN injury. Some significant operative events were associated with nerve injuries.
Nerve injury in third molar surgery can be predicted based on some radiographic risk factors and some unforeseen intraoperative events. Most of the injuries are transitory in nature.
下牙槽神经（IAN）、舌神经（LN）和颊长神经（LBN）是三叉神经的三个终末分支，在拔除下颌阻生第三磨牙的手术过程中容易受到损伤。虽然并不总是能够准确预测哪些患者会出现这些并发症，但了解和识别风险因素可能有助于针对特定病例采用适当的技术和专业知识。我们开展这项研究，旨在记录拔除下颌阻生第三磨牙手术后下牙槽神经（IAN）、舌神经（LN）和颊长神经（LBN）损伤的发生率和持续时间，并确定相关的影像学和手术风险因素。
对79例接受单侧下颌阻生第三磨牙拔除术的患者进行术前和术后神经感觉测试，以确定神经损伤并发症的发生率和持续时间。在影像学变量和记录的手术事件中确定神经损伤的风险因素。
报告的IAN损伤发生率为6.6%，LN损伤发生率为2.6%，LBN损伤发生率为4.0%；除1例神经损伤外，其余均在2周内恢复。阻生深度（Pell & Gregory C级）和舌侧倾斜分别是IAN和LN损伤的显著风险因素，而未检测到LBN损伤的风险因素。一些重大手术事件与神经损伤有关。
基于一些影像学风险因素和一些不可预见的术中事件，可以预测第三磨牙手术中的神经损伤。大多数损伤本质上是暂时的。
