Verweij Jop P, van Hof Kira S, Malessy Martijn J A, van Merkesteyn Richard
*Department of Oral and Maxillofacial Surgery †Department of Neurosurgery, Leiden University Medical Centre, Leiden, The Netherlands.
J Craniofac Surg. 2017 Mar;28(2):496-500. doi: 10.1097/SCS.0000000000003354.
Iatrogenic lingual nerve lesion is a well-known and unfortunate complication after mandibular third molar removal. Occasionally, the nerve injury can cause severe neuropathic pain.Here, the authors present the history of 2 patients with lingual nerve injury due to mandibular third molar removal, and with severe neuropathic pain in the craniomandibular region. Pharmacotherapy and physiotherapy did not reduce the pain, and ultimately, the lingual nerve was surgically explored. Scar tissue and a lingual nerve neuroma were observed and resected in both patients.In the first patient, the gap between the nerve stumps was bridged with an autologous sural nerve graft. In the second patient, some continuity of the lingual nerve was preserved and the resected part was substituted with an autologous sural nerve graft. Significant pain reduction was achieved in both patients and no further medical treatment was necessary at the end of follow-up.These reports show that lingual nerve reconstruction can be a successful therapy in patients experiencing severe neuropathic pain after iatrogenic lingual nerve injury. Different treatment options for neuropathic pain due to lingual nerve injury are discussed.
医源性舌神经损伤是下颌第三磨牙拔除术后一种广为人知且不幸的并发症。偶尔，神经损伤会导致严重的神经性疼痛。在此，作者介绍了2例因下颌第三磨牙拔除导致舌神经损伤且在颅下颌区域伴有严重神经性疼痛患者的病史。药物治疗和物理治疗均未能减轻疼痛，最终对舌神经进行了手术探查。在两名患者中均观察到瘢痕组织和舌神经神经瘤并将其切除。在第一例患者中，神经残端之间的间隙用自体腓肠神经移植桥接。在第二例患者中，舌神经的部分连续性得以保留，切除部分用自体腓肠神经移植替代。两名患者的疼痛均显著减轻，随访结束时无需进一步治疗。这些报告表明，舌神经重建对于医源性舌神经损伤后出现严重神经性疼痛的患者可能是一种成功的治疗方法。文中还讨论了舌神经损伤所致神经性疼痛的不同治疗选择。
