Miloro Michael, Criddle Thalia-Rae
Professor and Head, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois, Chicago, IL.
Resident, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Illinois, Chicago, IL.
J Oral Maxillofac Surg. 2018 Dec;76(12):2669-2675. doi: 10.1016/j.joms.2018.06.001. Epub 2018 Jun 11.
Iatrogenic damage to the inferior alveolar nerve (IAN) and lingual nerve (LN) may occur during routine oral and maxillofacial surgery procedures. The primary aim of this study was to determine, using a prospective, double-blind, randomized controlled clinical trial, whether the proportion of nerve-injured patients with postoperative neurosensory improvement over a 3-month period differed significantly between a control group and a low-level laser therapy (LLLT) group.
The study sample consisted of 35 patients with iatrogenic nerve injury due to third molar odontectomy, dental implant placement, or local anesthetic injection. The investigators used a randomized, double-blind laser delivery system to administer either placebo or LLLT to patients who met the inclusion criteria. The outcome variable of neurosensory improvement was defined as a minimum 1-unit increase from baseline in visual analog scale rating and was based on standard objective clinical neurosensory testing. Study variables included the affected nerve (IAN or LN) and time from injury to treatment (3 to 12 months or >12 months). Univariate statistical analysis (χ test) was performed to determine significance between the groups.
Neurosensory improvement was observed in 46.7% of the LLLT patients, who showed at least a 1-unit improvement at 3 months, compared with 38.5% improvement for controls (P = .66), regardless of the specific nerve involved (IAN or LN). In addition, no observed difference was noted between the study groups based on time from injury to treatment.
This study failed to provide sufficient evidence to conclude that a difference in neurosensory improvement exists between the LLLT and placebo groups with IAN or LN injuries. However, this study is unique in the prospective double-blind study design and comprehensive neurosensory testing protocols. There is a continued need for further clinical studies on LLLT in oral and maxillofacial surgery nerve injuries.
在常规口腔颌面外科手术过程中，可能会发生医源性下牙槽神经（IAN）和舌神经（LN）损伤。本研究的主要目的是通过一项前瞻性、双盲、随机对照临床试验，确定在3个月期间神经损伤患者术后神经感觉改善的比例在对照组和低强度激光治疗（LLLT）组之间是否存在显著差异。
研究样本包括35例因第三磨牙拔除术、牙种植体植入或局部麻醉注射导致医源性神经损伤的患者。研究人员使用随机、双盲激光发射系统，对符合纳入标准的患者给予安慰剂或LLLT治疗。神经感觉改善的结果变量定义为视觉模拟量表评分较基线至少增加1个单位，且基于标准的客观临床神经感觉测试。研究变量包括受影响的神经（IAN或LN）以及从损伤到治疗的时间（3至12个月或>12个月）。进行单变量统计分析（χ检验）以确定两组之间的显著性。
在LLLT组中，46.7%的患者在3个月时神经感觉得到改善，表现为至少增加1个单位，而对照组的改善率为38.5%（P = 0.66），无论涉及的具体神经是IAN还是LN。此外，根据从损伤到治疗的时间，两组之间未观察到差异。
本研究未能提供充分证据得出LLLT组与安慰剂组在IAN或LN损伤后神经感觉改善存在差异的结论。然而，本研究在前瞻性双盲研究设计和全面的神经感觉测试方案方面具有独特性。对于LLLT在口腔颌面外科神经损伤中的应用，仍需要进一步的临床研究。
