Almohammadi Turki, Yates Julian, Aljohani Marwan, Alshehri Sami
Department Oral and Maxillofacial Surgery, College of Dentistry, Jouf University, Sakaka, Saudi Arabia.
Faculty of Biology, Medicine and Health, Division of Dentistry, the University of Manchester, United Kingdom.
Saudi Dent J. 2024 Apr;36(4):499-508. doi: 10.1016/j.sdentj.2023.12.018. Epub 2023 Dec 29.
To investigate the effectiveness of the microsurgical treatment in restoring full sensory recovery following trigeminal nerve injuries caused by iatrogenic oral and maxillofacial surgical interventions.
A detailed search was conducted on the Cochrane central register of controlled trials, Medline and Embase. Clinical studies with at least twelve months of follow up were included and assessment of risks of bias was made using the Robbin I assessment tool
Six studies were identified in the searches which include 227 patients. The lingual nerve was the most common injured nerve, followed by the inferior alveolar nerve. Third molar removal was the most frequent cause of nerve injury, followed by root canal treatment, pathology excision, coronectomy, orthognathic surgery, dental implants and then local anaesthetic injections. Overall, surgical interventions for nerve injuries showed neurosensory improvement postoperatively in the majority of patients.
Direct neurorrhaphy is still the gold-standard technique when the tension at the surgical site is minimal. Promising results have been noted on conduit applications following traditional repair or grafting. Further research is needed on the efficacy of allografting and conduit applications in nerve repair.
探讨显微外科治疗在恢复医源性口腔颌面外科手术干预所致三叉神经损伤后完全感觉恢复方面的有效性。
对Cochrane对照试验中央注册库、Medline和Embase进行了详细检索。纳入至少随访12个月的临床研究，并使用Robbin I评估工具进行偏倚风险评估。
检索到6项研究，共纳入227例患者。舌神经是最常受伤的神经，其次是下牙槽神经。拔除第三磨牙是神经损伤最常见的原因，其次是根管治疗、病理切除、冠切除术、正颌手术、牙种植体植入，然后是局部麻醉注射。总体而言，大多数患者术后神经损伤的手术干预显示神经感觉有所改善。
当手术部位张力最小时，直接神经缝合仍是金标准技术。传统修复或移植后应用导管已取得了有前景的结果。关于同种异体移植和导管应用在神经修复中的疗效，还需要进一步研究。
