Alhyari Rahmeh, Ross P J, Sacco R, AlHadidi A, Mitchell J, Khalaf K, Lalli A
Institute of Dentistry, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill Campus, Cornhill Road, Aberdeen, AB25 2ZR, UK.
Oral and Maxillofacial Surgery, Faculty of Dentistry, Zarqa University, P.O. BOX 2000, Zarqa, 13110, Jordan.
BMC Oral Health. 2025 Jul 25;25(1):1237. doi: 10.1186/s12903-025-06589-9.
Recent advancements in MRI, with its superior soft tissue resolution and ionising radiation-free nature, provide a promising solution for the limitations of current imaging modalities. This review aims to evaluate whether MRI can be utilised to reduce the risk of lingual nerve (LN) injury during mandibular third molar surgery (M3M).
Following PRISMA guidelines, the protocol was registered in PROSPERO (CRD42024625994). A systematic literature search was employed across MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, and Science Direct without language or date restrictions. Studies assessing MRI's ability to visualise the LN and surgically relevant anatomy were included. The risk of bias was evaluated using ROBINS-I. Given the heterogeneity of included studies, this review was conducted as a scoping review to explore the range of evidence available, and findings were summarised through narrative synthesis.
Fourteen studies met the inclusion criteria. While none directly assessed whether MRI reduces the incidence of LN injury, it consistently demonstrated superior LN visualisation compared to conventional imaging. Among the sequences evaluated, Three-dimensional Double-Echo Steady-State with Water Excitation (3D-DESS-WE) and Sampling Perfection with Application-optimised Contrasts using different flip angle Evolutions with Short Tau Inversion Recovery (SPACE-STIR) provided nerve delineation and anatomical clarity. However, variability in scan duration, availability of MRI, the need for specialised image interpretation, and only moderate inter-observer agreement currently limit the clinical application of MRI in M3M surgery.
Definitive evidence of the efficacy of MRI in reducing nerve injury during M3M is lacking. However, moderate to low quality evidence suggests that MRI offers superior visualisation of the LN compared to conventional imaging. Further clinical trials are needed to evaluate whether MRI's enhanced preoperative visualisation translates into improved clinical outcomes from M3M surgery.
磁共振成像（MRI）近年来取得了进展，具有卓越的软组织分辨率且无电离辐射，为克服当前成像方式的局限性提供了一个有前景的解决方案。本综述旨在评估MRI是否可用于降低下颌第三磨牙手术（M3M）期间舌神经（LN）损伤的风险。
按照系统评价与 Meta 分析的首选报告项目（PRISMA）指南，该方案已在国际前瞻性系统评价注册库（PROSPERO）中注册（注册号：CRD42024625994）。在 MEDLINE/PubMed、Scopus、Web of Science、Cochrane 图书馆和 Science Direct 数据库中进行了系统的文献检索，检索无语言或日期限制。纳入评估MRI可视化舌神经及手术相关解剖结构能力的研究。使用 ROBINS - I评估偏倚风险。鉴于纳入研究的异质性，本综述作为一项范围综述进行，以探索现有证据的范围，并通过叙述性综合总结研究结果。
14项研究符合纳入标准。虽然没有研究直接评估MRI是否降低舌神经损伤的发生率，但与传统成像相比，MRI始终显示出更优的舌神经可视化效果。在所评估的序列中，水激发三维双回波稳态序列（3D - DESS - WE）和采用不同翻转角演化的短反转恢复序列的应用优化对比度采样完美序列（SPACE - STIR）能够清晰显示神经并提供解剖结构清晰度。然而，扫描时间的变异性、MRI设备的可用性、对专业图像解读的需求以及目前观察者间仅为中等程度的一致性，这些因素目前限制了MRI在M3M手术中的临床应用。
缺乏MRI在降低M3M手术期间神经损伤有效性的确切证据。然而，中低质量证据表明，与传统成像相比，MRI对舌神经的可视化效果更佳。需要进一步的临床试验来评估MRI增强的术前可视化是否能转化为M3M手术更好的临床结局。
