Department of Maxillofacial Surgery and Diagnostic Sciences, King Saud bin AbdulAziz University for Health Sciences, Riyadh, Saudi Arabia.
Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Int J Oral Maxillofac Surg. 2021 Jun;50(6):820-829. doi: 10.1016/j.ijom.2020.10.002. Epub 2020 Nov 6.
This systematic review and exploratory meta-analysis of the available evidence was performed to examine whether early nerve repair of lingual nerve (LN) and inferior alveolar nerve (IAN) injuries has an effect on neurosensory recovery. A literature search was conducted to identify relevant studies meeting the inclusion criteria. Two reviewers independently evaluated the methodological quality of the included studies and the risk of bias using the ROBINS-I quality assessment tool. For the quantitative analysis, data were pooled using the Mantel-Haenszel random-effects method due to the clinical heterogeneity across the studies. Sensitivity and subgroup analyses were performed based upon the group definition of timing from injury to nerve repair, with breakpoints of 2, 3, and 6 months. A total 1236 citations were identified, with a final 13 studies included in the systematic review. A clear definition of 'early' versus 'late' repair was not reported in six studies, allowing only seven to be included in the meta-analysis. The effect of early repair on functional sensory recovery was found not to be significant in nine studies, while four studies found a significant effect of early intervention. The meta-analysis showed a combined success rate of 93.0% for the early group and 78.5% for the late group. The odds of improvement were 5.49 (95% confidence interval 1.40-21.45) in the 3-month breakpoint studies and 2.28 (95% confidence interval 1.05-4.98) in the 6-month studies. A trend towards early repair achieving better functional sensory recovery outcomes was observed, but the specific time period is unknown.
这是一项系统评价和探索性荟萃分析，旨在研究早期修复舌神经（LN）和下牙槽神经（IAN）损伤是否对神经感觉恢复有影响。进行了文献检索，以确定符合纳入标准的相关研究。两位审查员使用 ROBINS-I 质量评估工具独立评估纳入研究的方法学质量和偏倚风险。由于研究之间存在临床异质性，因此使用 Mantel-Haenszel 随机效应方法对数据进行了汇总进行定量分析。根据从损伤到神经修复的时间定义的分组定义，进行了敏感性和亚组分析，时间断点为 2、3 和 6 个月。共确定了 1236 条引文，最终有 13 项研究纳入系统评价。六项研究未明确报告“早期”与“晚期”修复的定义，仅允许其中七项研究纳入荟萃分析。9 项研究发现早期修复对功能感觉恢复没有显著影响，而四项研究发现早期干预有显著效果。荟萃分析显示，早期组的综合成功率为 93.0%，晚期组为 78.5%。在 3 个月时间点的研究中，改善的可能性为 5.49（95%置信区间 1.40-21.45），在 6 个月时间点的研究中为 2.28（95%置信区间 1.05-4.98）。观察到早期修复更有可能实现更好的功能感觉恢复结果的趋势，但具体时间点尚不清楚。
