Interventions for iatrogenic inferior alveolar and lingual nerve injury
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Publisher
DOI
10.1002/14651858.CD005293.pub2
Journal
COCHRANE DATABASE OF SYSTEMATIC REVIEWS
Issue
ISSN
1469-493X
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BackgroundIatrogenic injury of the inferior alveolar or lingual nerveor both is a known complication of oral and maxillofacial surgery procedures.Injury to these two branches of the mandibular division of thetrigeminal nerve may result in altered sensation associatedwith theipsilateral lower lip or tongue or both and may include anaesthesia, paraesthesia, dysaesthesia, hyperalgesia, allodynia, hypoaesthesiaand hyperaesthesia. Injury to the lingual nerve may also affect taste perception on the affected side of the tongue. The vastmajority(approximately 90%) of these injuries are temporary in nature and resolve within eight weeks. However, if the injury persists beyond sixmonths it is deemed to be permanent. Surgical, medical and psychological techniques have been used as a treatment for such injuries,though at present there is no consensus on the preferred intervention, or the timing of the intervention.ObjectivesTo evaluate the effects of different interventions and timings of interventions to treat iatrogenic injury of the inferior alveolar or lingualnerves.Search methodsWe searched the following electronic databases: the Cochrane Oral Health Group’s Trial Register (to 9 October 2013), the CochraneCentral Register of Controlled Trials (CENTRAL) (The Cochrane Library2013, Issue 9), MEDLINE via OVID (1946 to 9 October2013) and EMBASE via OVID (1980 to 9 October 2013). No language restrictions were placed on the language or date of publicationwhen searching the electronic databases.Selection criteriaRandomised controlled trials (RCTs) involving interventions to treat patients with neurosensory defect of the inferior alveolar or lingualnerve or both as a sequela of iatrogenic injury.Data collection and analysisWe used the standard methodological procedures expected by TheCochrane Collaboration. We performed data extraction and assess-ment of the risk of bias independently and in duplicate. We contacted authors to clarify the inclusion criteria of the studies.
Main resultsTwo studies assessed as at high risk of bias, reporting data from 26 analysed participants were included in this review. Theage range ofparticipants was from 17 to 55 years. Both trials investigated the effectiveness of low-level laser treatment compared to placebo lasertherapy on inferior alveolar sensory deficit as a result of iatrogenic injury.Patient-reported altered sensation was partially reportedin one study and fully reported in another. Following treatment with lasertherapy, there was some evidence of an improvement in the subjective assessment of neurosensory deficit in the lip and chin areascompared to placebo, though the estimates were imprecise: a difference in mean change in neurosensory deficit of the chin of 8.40 cm(95% confidence interval (CI) 3.67 to 13.13) and a difference in mean change in neurosensory deficit of the lip of 21.79 cm (95% CI5.29 to 38.29). The overall quality of the evidence for this outcome was very low; the outcome data were fully reported in one smallstudy of 13 patients, with differential drop-out in the control group, and patients suffered only partial loss of sensation. No studiesreported on the effects of the intervention on the remaining primary outcomes of pain, difficulty eating or speaking or taste. No studiesreported on quality of life or adverse events.The overall quality of the evidence was very low as a result of limitations in the conduct and reporting of the studies, indirectness ofthe evidence and the imprecision of the results.Authors’ conclusionsThere is clearly a need for randomised controlled clinical trials to investigate the effectiveness of surgical, medical and psychologicalinterventions for iatrogenic inferior alveolar and lingual nerve injuries. Primary outcomes of this research should include: patient-focused morbidity measures including altered sensation and pain, pain, quantitative sensory testing and the effects of delayed treatment