Maxillo-Facial Surgery
Welcome to the specialist
section on maxillo-facial surgery.
We invite letters, articles, papers
and suggestions to the editor from professionals
with a special interest in this particular discipline.
We open with a discussion instigated
by a letter received from a patient
.
I have lingual nerve damage from
a wisdom tooth extraction which has resulted in parastegia to the tongue and
inner gum. I have been advised that a nerve graft from the ankle is possible,
but very risky. Is there any non-invasive procedure that I can try which may
help my condition. Some research has indicated that low level laser treatment
may be considered. I would be very interested in any advice that you can offer.
Dr. Keith Webster writes:
The incidence of lingual nerve damage
following third molar surgery ranges from 0.6% to 22%, although this may reduce
to about 0.6% at 1 year indicating neuropraxia as the mechanism of injury rather
than neurontomesis (Carmichael & McGowan).
Section injuries are more likely to result in sensory abnormalities than crush
injuries. By careful sensory testing using touch and moving two point discrimination
at three months post injury may allow the clinician to distinguish those patients
who are likely to recover or not. ( Blackburn)
There are many exponents of surgical exploration and repair of the divided nerve
(Riedinger et al.). The traditional method or repair is
by using epineural suture. The process of entubulation where the proximal and
distal ends of the nerve are introduced into a tubular structure has been shown
to be helpful in nerve regeneration to bridge short gaps between nerves (Fields)
The method of repair mentioned in the question is by taking a section of sural
nerve from the lower leg (a sensory nerve) via a skin incision on the outer aspect
of the lower leg and suturing this graft by epineural sutures between the divided
ends of the transected nerve. This of course assumes the nerve has been transected.
It is only when the area is surgically explored that it becomes apparent what
the type of nerve injury is. If the nerve has been transected and requires an
interpositional graft, it is thus prudent to consent the patient to such a graft
pre-operatively.
The idea of using low level laser treatment is unlikely to help as this is merely
a form of thermal heat treatment and does not address the underlying injury.
Success rates have improved via advancement in microsurgical techniques but the
usual advice of choosing a surgeon who has expertise in this area still applies
References:
Carmichael F.A., McGowan
D.A. (1992)Incidence of nerve damage following third molar removal: A
West of Scotland Oral Surgery Research Group Study British Journal of Oral &
Maxillofacial Surgery 30, 78-82
Blackburn C.W. (1990) A method of assessment in cases of lingual
nerve injury. British Journal of Oral & Maxillofacial Surgery 28, 238-245.
Riedinger D, Ehrenfeld M, Cornelius C.P. (1989) Micronerve surgery
on the inferior alveolar and lingual nerve with special consideration for nerve
replacement. In: Microsurgical tissue transplantation, D. Riediger and
M. Ehrenfeld (eds.) pp 189-194 Quintessence Publishing Co. Inc.
Fields R.D., LeBeau J.M., Longo F.M., Ellisman M.H. (1989) Nerve
regeneration through artificial tubular implants. Prog. Neurobiol 33, 87-134.
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