Lingual nerve injury

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Lingual nerve injury

• Dept.of OMFS
• Gachon Medical School
• Gil Medical Center
• Kim Hyeon Min

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Prescription

• Anatomy
• Morphology Factors
• Influence
• Classification
• Treatment
• Conclusion
• Reference

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Anatomy

• Peripheral distribution
• -Sensory of 2/3 tongue
• lower lingual gingivae
• -Special sensory fibers
• for taste
• Parasympathetic preganglionic fibers for
  submandibular ganglion (sublingual
  submandibular glands)

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???? 2/3 tongue lower lingual gingivaemouth
floor ?? ??,??facial N? ??? chorda tympanic N?
2/3 tongue ??? ?? by ??? 2000 ?
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Clinical Anatomic observations on the relations
of the Lingual Nerve to the Mandibular 3rd Molar
Lesion

• J Oral Maxillofac Sur 42565,1984 By
  Kiesselbach(1984)
• ???? ???? ?? ??
• ??? ?? ?????? 2mm?? 7mm
• ??? ?? ??? ???? 03mm

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Factors

• ?????
• ??? ?? ? ?????
• ??? ?? ?
• ??
• ???? ???? ??
• ???? ??? ???? ??
• ?? ??? preparation? bur? disc? ??
• ????
• By Jacks?(1998),Griffiths?(1
  999), etc

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Patterns of furcation of LN IAN

• Type I 65.6
• Type II 25.0
• Type III 3.1
• Type IV 6.3
• -??? 2? ??? ????? ???? ??? ? ??

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Skull base? hamular process?? LN IAN furcation
vertical distance

• A14.3(7.824.1)mm
• B16.5(4.924.3)mm
• C 4.0(07.7)mm
• -lingula? ????? ?? medial horizontal osteotomy?
  ????

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Morphological classifications based on joining
level of CTN to LN

• typeI 59.4 typeII 28.1
  type III 12.5
• -LN ??? ?????? ???? ?? ?? ??? ?? ?? ???? ???? ???
  ??? LN? ??? CTN(chorda tympani nerve)? ??? ?? ?
  ?? ??? ??? ???
• By
  Alling1986,Girod1989,Jones1992

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Cross sectional morphology

• Retromolar 3rd molar 2nd
  molar
• Mx diameter 2.3mm 3.3mm 3.0mm
• -???? ? ??? ????? ????? ???
• -CTN? LN ?? ??? ?? ???? ????? ??? ????? ?? ?? ???
  ???? ??? ???

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Distance between LN

• A 15.5(8.719.9)mm
• B 9.5(5.116.1)mm
• C 7.8(3.514.2)mm
• Kisselbach etc 17.6/ Behnia(2000) etc 10
• -????? lingual alveolar crest ??? ??? ???? ???
  ??? ????? ??? ?? ??
• ???? lingual alveolar crest 3mm??? ???? ???? ???
  ?? ??
• -lingual gingivae incision? ??? ???
• -molar lingual? ??? ????? lingual alveolar bone
  fx?? ???? bony margin? ?? ??

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Crossing of LN SMD

• 2nd molar(D) 40.8 3rd molar(mid) 37
• -SMD(submandibular duct)? ??? mouth floor
  surgery? ????? ?? ??? ?? ???? ?? ??? ???.

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Factors after 3rd molar removal

• Poor flap design
• Clumsy instrumentation
• Fracture of lingual plate
• Raising retraction of lingual mucoperiosteal
  elevator by
  Bataineb AB 2001. JOMS
• -Reducing op time, avoiding bone cutting damage,
  minimizing residual bone defects - Lingual flap
• 
  by David AM 2001.joms

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Sensory Nerve Impairment Following Mandibular
Third Molar Surgery

• J.Oral Maxillofac Surg 591012-1017,2001 by
  Bataineb AB
• Rate post op lingual N parsthesia
• 19/741(2.6)
• post op IAN paresthesia
• 29/741(3.9)
• Factors raising of lingual flap
• experience of operator
• Other references 0.62.0
• (LN injury during 3rd molar extraction)
• by Behnia
  2000,Alling 1984,etc

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Influence by LN injury

• Tongue ant. 2/3 ?? ?? ??
• ??? ?? ????? ??
• -LN? ????? ???? ????? ??? ????? ??? ?? ????
  ?????? ??? ????? ??? ??? ??. By Himmelfarb (1985)

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classification

• 1? neuropraxia
• -???,??? ??
• -Type I 24?? ??
• Type II 12? ??
• Type III 12?? ??
• 2? axonotmesis
• -???? ????? ??
• -??? ??? ??? 26??? ??? ?? ?? ??
• 3? neurotmesis
• -24?? ?? ??? ??
• -4? 612???? ??? ??
• -5? ?? ?? ???
• By Herbert Seddon(1943)
• Sydney Sunderland(1978)

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Diagnosis

• Question-??? ??? ?? ??
• 1)??? ??? ?? ? ?? ??
• 2)?? ?? ?? ??? ?? ??
• ????? ??? ?? ??
• 1)contact threshold(??????)
• 2)direction (??????)
• 3)two-point discrimination(??????)
• 4)pin prick(????)
• 5)thermal discrimination(??????)
• 6)current perception threshold(??????)

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• contact threshold(??????)
• -Weinstein-Semmes filaments?? 11.5??
• -??? ????
• direction (??????)
• -???????? ?? ?? ?? ??
• -1cm?? 1520?
• -5075??? ????
• two-point discrimination(??????)
• -23G needle ??? ?? 1??
• -2mm ????
• pin prick(????)
• -23G needle dial gauge ??
• -100g/150g ???? ???
• thermal discrimination(??????)
• -???? ??? ?? 1?? 3?
• -2/3???? ??
• current perception threshold(??????)
• -neurometer??

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Treatment
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???? ??? ??

• Anastomosis
• -??? ???
• -??,??? ???
• -25g ?? ??? ??
• -34? ???? ??
• -IAN,LN ????? ??? ???
• -9-0,10-0 Nylon??
• Methods
• Preparation of stumps(???? ??)
• Approximation(??? ??)
• Coaptation(??? ??)

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• Decompression
• ??? ????,???? ?? ????? ?? ? ??
• neurapraxia,axonotmesis ??? ?? ??????? ??? ???
  ????? ??? ??? ?? ?
• -?????
• -?????

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• Grafting
• -indication
• ??? ??? ??? ???
• neurotmesis,axonotmesis? ????? ?? ????? ????
• ??? ???? ??? ?? ?
• -??
• sural N
• great auricular N
• median antebrachial N
• Alloplastic tubes(Gore-Tex)
• Freeze-dried muscle grafts
• Autogenous vein grafts

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The Use of Autogenous Vein Grafts for IAN LN
Reconstruction

• J. Oral Maxillofac Surg 599852001 by Pogrel MA
• Vein graft can form physiologic conduit for N
  regeneration
• More successful with shorter gaps
• Lack of lingual N gap repair d/t tongue movement
• Less than 5mm-good/some return

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• Non sutured nerve repair
• -fibrin sealant? ????? ????? ?? ??

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??? ????? ??? ? ????

• 1)???? ?? ? ? 4??
• 2)???? ?? 12?? observation
• ? 2/3 ???? ???
• ? ?? ????? ???? ???? ?? surgical approach
• 3)Prognosis
• Intraoral approach difficulty
• ??? ?? ??? ??? ??
• ???? ???? ????? ??

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Conclusion

• ??????? dysthesia 0.6-5
• IAN 2.6, LN 0.6
• ??? ?? IAN 96, LN 87
• ???? 6-8???? ??, ??? 9-12???? ??
• 9??? ?? ? ???? ??? ?? ??. by ??? ??????? ??? ?
  ? ??, ??? ????????? 2003 .4

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• ?? ??, ???? ?? ??, bur? ?? ??? ??, ????? ??,
  lingual mucoperiosteal flap retraction? ??? ???
  ??? ??
• ???? ?? ????? ???? ???
• ??? buccal instrumentation
• ??? ?? ???? ??

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Reference

• ???? ????? ? ??? ?? ??? ?? ??? ?? ??? ??-?? ?
  ?? ?? ??.?????????????? 25114-121,2003
• ???????? ???
• ??? ??????? ??? ? ? ??, ??? ????????? 2003 .4
• ??????? ???? ?? ? ????.?????????? 27118,2001

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• Thank you for your attention !!!