Fujita Shigeyuki, Tojyo Itaru, Suzuki Shigeru, Tajima Fumihiro
Oral and Maxillofacial Surgery, Wakayama Medical University, Kimiidera 811-1, Wakayama City, 641-8509, Japan.
Rehabilitation Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, 641-8510, Japan.
Maxillofac Plast Reconstr Surg. 2023 Jun 19;45(1):21. doi: 10.1186/s40902-023-00389-3.
Extraction of the mandibular third molar, the most frequent and important surgical procedure in the clinical practice of oral surgery, is associated with the risk of injury of the lingual nerve. Neuropathy of the lingual nerve poses diagnostic challenges regarding the transient or permanent nature of the injury. No consensus or criteria have been established regarding the diagnosis of lingual nerve neuropathy. We applied both Tinel's test and clinical neurosensory testing together, which can be easily used at the bedside in the early stages of injury. Therefore, we propose a new method to differentiate between lesions with the ability to heal spontaneously and those that cannot heal without surgery.
Thirty-three patients (29 women, 4 men; mean age, 35.5 years) were included in this study. For all patients, the median interval between nerve injury and initial examination was 1.6 months and that between nerve injury and the second examination before determining the need for surgical management was 4.5 months. The patients were assigned to either group A or B. The spontaneous healing group (group A, n = 10) revealed a tendency for recovery within 6 months after tooth extraction. In this group, although there were individual differences in the degree of recovery, a remarkable tendency for recovery was observed based on clinical neurosensory testing in all cases. None of the patients were diagnosed with allodynia. In seven cases, the Tinel test result was negative at the first inspection, and in three cases, the result changed to negative at the second inspection. Conversely, in group B(n = 23), no recovery trend was observed with regard to clinical neurosensory testing, and nine patients had allodynia. Further, the Tinel test result was positive for all patients in both examinations.
Our findings indicate that in case of transient lingual nerve paralysis, clinical neurosensory testing findings deteriorate immediately after tooth extraction and gradually recover, while Tinel's test shows a negative result. Using Tinel's test and clinical neurosensory testing together enabled early and easy identification of the severity of the lingual nerve disorder and of lesions that would heal spontaneously without surgical management.
下颌第三磨牙拔除术是口腔外科临床实践中最常见且重要的外科手术，该手术存在舌神经损伤风险。舌神经病变在损伤的短暂性或永久性方面带来了诊断挑战。关于舌神经病变的诊断，尚未达成共识或确立标准。我们将Tinel试验和临床神经感觉测试联合应用，其在损伤早期可于床边轻松进行。因此，我们提出一种新方法，以区分能够自发愈合的病变和未经手术无法愈合的病变。
本研究纳入33例患者（29例女性，4例男性；平均年龄35.5岁）。所有患者神经损伤至初次检查的中位间隔时间为1.6个月，神经损伤至确定是否需要手术治疗前的第二次检查的中位间隔时间为4.5个月。患者被分为A组或B组。自发愈合组（A组，n = 10）在拔牙后6个月内有恢复趋势。在该组中，尽管恢复程度存在个体差异，但基于临床神经感觉测试，所有病例均观察到明显的恢复趋势。无一例患者被诊断为异常性疼痛。7例患者初次检查时Tinel试验结果为阴性，3例患者第二次检查时结果变为阴性。相反，在B组（n = 23）中，临床神经感觉测试未观察到恢复趋势，9例患者有异常性疼痛。此外，两次检查中所有患者的Tinel试验结果均为阳性。
我们的研究结果表明，在短暂性舌神经麻痹的情况下，拔牙后临床神经感觉测试结果立即恶化并逐渐恢复，而Tinel试验显示阴性结果。联合使用Tinel试验和临床神经感觉测试能够早期且轻松地识别舌神经障碍的严重程度以及无需手术治疗即可自发愈合的病变。
