Title: Lingual nerve injury
1Lingual nerve injury
- Dept.of OMFS
- Gachon Medical School
- Gil Medical Center
- Kim Hyeon Min
2Prescription
- Anatomy
- Morphology Factors
- Influence
- Classification
- Treatment
- Conclusion
- Reference
3Anatomy
- Peripheral distribution
- -Sensory of 2/3 tongue
- lower lingual gingivae
- -Special sensory fibers
- for taste
- Parasympathetic preganglionic fibers for
submandibular ganglion (sublingual
submandibular glands)
4???? 2/3 tongue lower lingual gingivaemouth
floor ?? ??,??facial N? ??? chorda tympanic N?
2/3 tongue ??? ?? by ??? 2000 ?
5(No Transcript)
6Clinical 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
7Factors
- ?????
- ??? ?? ? ?????
- ??? ?? ?
- ??
- ???? ???? ??
- ???? ??? ???? ??
- ?? ??? preparation? bur? disc? ??
- ????
- By Jacks?(1998),Griffiths?(1
999), etc
8Patterns of furcation of LN IAN
- Type I 65.6
- Type II 25.0
- Type III 3.1
- Type IV 6.3
- -??? 2? ??? ????? ???? ??? ? ??
9Skull 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?
????
10Morphological 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
11Cross sectional morphology
- Retromolar 3rd molar 2nd
molar - Mx diameter 2.3mm 3.3mm 3.0mm
- -???? ? ??? ????? ????? ???
- -CTN? LN ?? ??? ?? ???? ????? ??? ????? ?? ?? ???
???? ??? ???
12Distance 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? ?? ??
13Crossing of LN SMD
- 2nd molar(D) 40.8 3rd molar(mid) 37
- -SMD(submandibular duct)? ??? mouth floor
surgery? ????? ?? ??? ?? ???? ?? ??? ???.
14Factors 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
15Sensory 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
16Influence by LN injury
- Tongue ant. 2/3 ?? ?? ??
- ??? ?? ????? ??
- -LN? ????? ???? ????? ??? ????? ??? ?? ????
?????? ??? ????? ??? ??? ??. By Himmelfarb (1985)
17classification
- 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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20Diagnosis
- Question-??? ??? ?? ??
- 1)??? ??? ?? ? ?? ??
- 2)?? ?? ?? ??? ?? ??
- ????? ??? ?? ??
- 1)contact threshold(??????)
- 2)direction (??????)
- 3)two-point discrimination(??????)
- 4)pin prick(????)
- 5)thermal discrimination(??????)
- 6)current perception threshold(??????)
21- 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??
22Treatment
23(No Transcript)
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25???? ??? ??
- Anastomosis
- -??? ???
- -??,??? ???
- -25g ?? ??? ??
- -34? ???? ??
- -IAN,LN ????? ??? ???
- -9-0,10-0 Nylon??
- Methods
- Preparation of stumps(???? ??)
- Approximation(??? ??)
- Coaptation(??? ??)
26- Decompression
- ??? ????,???? ?? ????? ?? ? ??
- neurapraxia,axonotmesis ??? ?? ??????? ??? ???
????? ??? ??? ?? ? - -?????
- -?????
27- Grafting
- -indication
- ??? ??? ??? ???
- neurotmesis,axonotmesis? ????? ?? ????? ????
- ??? ???? ??? ?? ?
- -??
- sural N
- great auricular N
- median antebrachial N
- Alloplastic tubes(Gore-Tex)
- Freeze-dried muscle grafts
- Autogenous vein grafts
28The 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
29- Non sutured nerve repair
- -fibrin sealant? ????? ????? ?? ??
30??? ????? ??? ? ????
- 1)???? ?? ? ? 4??
- 2)???? ?? 12?? observation
- ? 2/3 ???? ???
- ? ?? ????? ???? ???? ?? surgical approach
- 3)Prognosis
- Intraoral approach difficulty
- ??? ?? ??? ??? ??
- ???? ???? ????? ??
31Conclusion
- ??????? dysthesia 0.6-5
- IAN 2.6, LN 0.6
- ??? ?? IAN 96, LN 87
- ???? 6-8???? ??, ??? 9-12???? ??
- 9??? ?? ? ???? ??? ?? ??. by ??? ??????? ??? ?
? ??, ??? ????????? 2003 .4
32- ?? ??, ???? ?? ??, bur? ?? ??? ??, ????? ??,
lingual mucoperiosteal flap retraction? ??? ???
??? ?? - ???? ?? ????? ???? ???
- ??? buccal instrumentation
- ??? ?? ???? ??
33Reference
- ???? ????? ? ??? ?? ??? ?? ??? ?? ??? ??-?? ?
?? ?? ??.?????????????? 25114-121,2003 - ???????? ???
- ??? ??????? ??? ? ? ??, ??? ????????? 2003 .4
- ??????? ???? ?? ? ????.?????????? 27118,2001
34- Thank you for your attention !!!