Department of oral and maxillofacial surgery, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Middle Yanchang Road 399, Shanghai, 200072, People's Republic of China.
Department of oral and maxillofacial surgery, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Middle Yanchang Road 399, Shanghai, 200072, People's Republic of China.
J Stomatol Oral Maxillofac Surg. 2020 Feb;121(1):63-69. doi: 10.1016/j.jormas.2019.06.010. Epub 2019 Aug 30.
This study analyzes the risk factors associated with the incidences of inferior alveolar nerve (IAN) injury after surgical removal of impacted mandibular third molar (IMTM) and to evaluate the contribution of these risk factors to postoperative neurosensory deficits.
An exhaustive literature search has been carried out in the COCHRANE library and PubMed electronic databases from January 1990 to March 2019 supplemented by manual searching to identify the related studies. Twenty-three studies out of 693 articles from the initial search were finally included, which summed up a total of 26,427 patients (44,171 teeth).
Our results have been compared with other current available papers in the literature review that obtained similar outcomes. Among 44,171 IMTM extractions performed by various grades of operators, 1.20% developed transient IAN deficit and 0.28% developed permanent IAN deficit respectively. Depth of impaction (P<0.001), contact between mandibular canal (MC) and IMTM (P<0.001), surgical technique (P<0.001), intra-operative nerve exposure (P<0.001), and surgeon's experience (P<0.001) were statistically significant as contributing risk factors of IAN deficits.
Radiographic findings, such as depth of impaction, proximity of the tooth to the mandibular canal, surgical technique, intra-operative nerve exposure, and surgeon's experience were high risk factors of IAN deficit after surgical removal of IMTMs.
本研究分析了下颌第三磨牙（IMTM）拔除术后下牙槽神经（IAN）损伤的相关风险因素，并评估这些风险因素对术后神经感觉缺陷的影响。
从 1990 年 1 月至 2019 年 3 月，在 COCHRANE 图书馆和 PubMed 电子数据库中进行了全面的文献检索，并通过手动搜索补充了相关研究。从最初的 693 篇文章中筛选出 23 篇研究，共计 26427 名患者（44171 颗牙）。
我们的结果与文献综述中其他当前可用的论文进行了比较，得出了相似的结果。在由不同级别医生进行的 44171 次 IMTM 拔除术中，分别有 1.20%发生暂时性 IAN 缺损，0.28%发生永久性 IAN 缺损。阻生深度（P<0.001）、下颌管（MC）与 IMTM 接触（P<0.001）、手术技术（P<0.001）、术中神经暴露（P<0.001）和医生经验（P<0.001）是 IAN 缺损的显著相关风险因素。
影像学表现，如阻生深度、牙齿与下颌管的接近程度、手术技术、术中神经暴露和医生经验是 IMTM 拔除术后 IAN 缺损的高风险因素。
