Microsurgical treatment of inferior alveolar and lingual nerve paresthesia

The surgical treatment on the mandible is associated with risk of important nerves structure damage, especially inferior mandibular nerve and lingual nerve. The most often cause of the nerve injuries are surgical removal of impacted wisdom teeth, dental implant malposition, sagittal split osteotomy of the mandibular ramus and surgical extractions of other impacted teeth in the lower jaw especially premolars. The best treatment is prevention by meticulous precise of surgical technique. But for this complication we have treatment options too - microsurgical reconstruction of the damaged nerves. On the few case presentations we would like to present our surgical protocol and its results. During last three years we performed microsurgical decompression, neurolysis, traumatic neuroma removal with or without "end to end" microsurgical suture or nerve transplantation from great retroauricular nerve in 28 patients. The 92 % of them had significant function improvement (62 % with normal function, 30 % with minor deficit), for 8 % patient surgery did not improve any function. Themost important factor is amount of time elapsed from nerve injury. Nerve revisions less than 6 months after injury are more successful (96 % of improvement) than after longer period. One year after injury our success rate is only 39 %. We would like to report about this not generally known surgical technique, which can improve patient life after some of trigeminal nerve branch injury.

Doc. MUDr. et MUDr. René Foltán, PhD

Department of Oral and Maxillofacial Surgery, Charles University, 1st Faculty of Medicine & General Teaching Hospital, Prague

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