Key Points
-
This study proposes a simplified method of assessing lingual nerve injuries subsequent to third molar surgery.
-
Two point discrimination sensitivity and neuropathic area were the only conventional tests to reliably identify nerve injury.
-
The subjective function score may identify patients at risk of permanent injury in the early post-operative period allowing expedition of their referral for specialist care.
Abstract
Objective To determine the sensitivity of conventional sensory assessment in monitoring lingual nerve recovery subsequent to third molar surgery and to evaluate if the assessment methods can be predictive of injury outcome.
Method A prospective case series of 94 patients presenting with lingual nerve injuries evaluated using objective mechanosensory and subjective methods during the recovery period of up to 12 months.
Results The conventional tests were often unable to diagnose the presence of injury due to variability and they were not predictive of outcome. As a result of this study, we are able to identify patients more likely to have permanent rather than temporary lingual nerve injury at four to eight weeks post injury, using patient reported subjective function. The subjective function test also minimises the requirements for specialist training or equipment providing an ideal method for general dental practice.
Conclusions The development of these simple subjective tests may enable us to identify which patients are at risk of permanent lingual nerve injuries in the early post injury phase, thus allowing expeditious therapy when indicated.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Mason DA . Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 1988; 17: 290–294.
de Beukelaer J G P, Smeele L E, van Ginkel F C . Is short-term testing after removal of mandibular third molars efficacious? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85: 366–370.
Eliav E, Gracely RH . Sensory changes in the territory of the lingual and inferior alveolar nerves following lower third molar extraction. Pain 1998; 77: 191–199.
Shafer DM, Frank ME, Gent JF, Fischer ME . Gustatory function after third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87: 419–428.
Blackburn CW . A method of assessment in cases of lingual nerve injury. Br J Oral and Maxillofac Surg 1990; 28: 238–245.
Schultze-Mosgau S, Reich RH . Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and recovery of sensitivity. Int J Oral Maxillofac Surg 1993; 22: 214–217.
Teerijoki-Oksa T, Jaaskelainen S, Forsell K, Forsell H . An evaluation of clinical and electrophysiologic tests in nerve injury diagnosis after mandibular sagittal split osteotomy. Int J Oral and Maxilofacial Surgery 2003; 32: 15–23.
Feldman JA, Essick GK, Zuniga JR, Phillips C . Interexaminer reliability of three subjective neurosensory tests. Int J Adult Orthod Orthognath Surg 1997; 12: 273–285.
Ylikontiola L, Kinnunen J, Oikarinen K . Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 1998; 27: 417–421.
Ylikontiola L, Kinnunen J, Laukkanen P, Oikarinen K . Prediction of recovery from neurosensory deficit after bilateral sagittal split osteotomy. Oral Surg Oral Med Oral Path Radiol Endod 2000; 90: 275–281.
Zuniga JR, Meyer RA, Gregg JM, et al. The accuracy of clinical neurosensory testing for nerve injury. J Oral Maxillofac Surg 1998; 56: 2–8.
Campbell RL, Shamaskin RG, Harkins SW . Assessment of recovery from injury to inferior alveolar and mental nerves. Oral Surg Oral Med Oral Path 1987; 64: 519–526.
Cunningham LL, Tiner BD, Clark GM et al. A comparison of questionnaire versus monofilament assessment of neurosensory deficit. J Oral Maxillofac Surg 1996; 54: 454–459.
Robinson PP, Smith KG . Lingual nerve damage during lower third molar removal: a comparison of two surgical methods. Br Dent J 1996; 180: 456–461.
Scrivani SJ, Moses M, Donoff RB, Kaban LB . Taste perception after lingual nerve repair. J Oral Maxillofac Surg 2000; 58: 3–5.
Gregg JM . Posttraumatic pain. Experimental trigeminal neuropathy. J Oral Surg 1971; 29: 260–267.
Mackinnon SE, Dellon AL . Surgery of the peripheral nerve. Pp 35–66. New York: Thieme Medical Publishers, 1988.
Bell-Krotoski J, Tomancik E . The repeatability of testing with Semmes-Weinstein monofilaments. J Hand Surg 1987; 12A: 155–161.
Zuniga JR, Essick GK . A contemporary approach to the clinical evaluation of trigeminal nerve injuries. Oral Maxillofac Surg Clin Nth America 1992; 4: 353–357.
Birch R, Bonney G, Wynn ParryCB . Surgical disorders of the peripheral nerves. Edinburgh: Churchill-Livingstone, 1998.
Fridrich KL, Holton TJ, Pansegrau KJ, Buckley MJ . Neurosensory recovery following the mandibular bilateral sagittal split osteotomy. J Oral Maxfac Surg 1995; 53: 1300–1306.
Chen N, Yang X, Zuniga JR . Quantitative studies of taste and fungiform papillae on the anterior human tongue. Zhonghua Kou Qiang Yi Xue Za Zhi 1998; 33: 140–142. (author's translation)
Robinson PP, Loescher AR, Smith KG . A prospective quantitative study on the clinical outcome of lingual nerve repair. Br J Oral Maxillofac Surg 2000; 38: 255–263.
Joshi A, Rood JP . External neurolysis of the lingual nerve. Int J Oral Maxillofac Surg 2002; 31: 40–43.
Cowan PW . Atrophy of fungiform papillae following lingual nerve damage – a suggested mechanism. Br Dent J 1990; 168: 95.
Zuniga JR . Multi modal scaling of sensory recovery. J Oral Maxillofac Surg 1990; 48: 85–89.
Dellon AL, Mackinnon SE, Crosby PM . Reliability of two-point discrimination measurements. J Hand Surg 1987; 12A: 693–636.
Acknowledgements
We would like to thank the patients that agreed to take part in this study.
Author information
Authors and Affiliations
Corresponding author
Additional information
Refereed paper
Rights and permissions
About this article
Cite this article
Renton, T., Thexton, A., Crean, SJ. et al. Simplifying the assessment of the recovery from surgical injury to the lingual nerve. Br Dent J 200, 569–573 (2006). https://doi.org/10.1038/sj.bdj.4813584
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sj.bdj.4813584
This article is cited by
-
Post-traumatic trigeminal neuropathy: correlation between objective and subjective assessments and a prediction model for neurosensory recovery
The Journal of Headache and Pain (2021)
-
Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome
BMC Oral Health (2017)
-
The quantitative sensory testing is an efficient objective method for assessment of nerve injury
Maxillofacial Plastic and Reconstructive Surgery (2015)
-
Post-implant neuropathy of the trigeminal nerve. A case series.
British Dental Journal (2012)
