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. 2021 Sep 25;10(19):4379.
doi: 10.3390/jcm10194379.

Clinical Significance of Intraoperative Exposure of Inferior Alveolar Nerve during Surgical Extraction of the Mandibular Third Molar in Nerve Injury

Sung-Woon On  1   2   3 , Seoung-Won Cho  2   3   4 , Soo-Hwan Byun  2   3   4 , Byoung-Eun Yang  2   3   4
Affiliations

Clinical Significance of Intraoperative Exposure of Inferior Alveolar Nerve during Surgical Extraction of the Mandibular Third Molar in Nerve Injury

Sung-Woon On et al. J Clin Med. .

Abstract

During extraction surgery, the inferior alveolar nerve (IAN) can occasionally be observed in the extraction socket of the mandibular third molar (M3). The purpose of this study was to investigate and compare the incidence of IAN injury in groups with and without intraoperative IAN exposure during surgical extraction of M3, and to identify additional risk factors for the IAN injury in addition to the IAN exposure. A total of 288 cases in 240 patients, who underwent surgical extraction of M3 by a single surgeon, were divided into the exposed group (n = 69) and the unexposed group (n = 219). The surgeon recorded the information regarding the procedure when the clinical observation of IAN exposure was made during the surgery. The incidence of IAN injury after the extraction surgery was significantly higher in the exposed group than in the unexposed group (4.3% versus 0%, p < 0.05). Paresthesia was recognized in three cases of the exposed group, but it showed complete recovery within three postoperative months. No case of permanent paresthesia was detected in both groups. According to the logistic regression, the only significant risk factor of IAN injury in the exposed group was the increase of age (OR 1.108, p < 0.05). Intraoperative IAN exposure during surgical extraction of M3 may show a higher incidence of IAN injury than the case without IAN exposure, representing an incidence of 4.3%. Even if the paresthesia associated with IAN exposure occurs, it is likely to be a temporary injury, and this risk may increase with age.

Keywords: cone-beam computed tomography; inferior alveolar nerve; oral surgery; peripheral nerve injury; third molar surgery.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart showing the process of case selection. M3, mandibular third molar; IAN, inferior alveolar nerve.
Figure 2
Figure 2
Classification of the course of IAN canal by Ohman et al. [13]: buccal (leftmost); lingual (middle left); inferior (middle right); inter-radicular (rightmost).
Figure 3
Figure 3
Classification of the relationship of the mandibular third molar to the lingual cortex by Ohman et al. [13]: no contact (left); contact, thinning (middle); contact, perforation (right).
Figure 4
Figure 4
Clinical photos showing intraoperative IAN exposure (white arrows) in the extraction socket of the mandibular third molar during surgery.
See this image and copyright information in PMC

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