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Lingual nerve injury

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... Freeze-dried muscle grafts Autogenous vein grafts The Use of Autogenous Vein Grafts for IAN & LN Reconstruction J. Oral Maxillofac Surg 59;985; ... – PowerPoint PPT presentation

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Title: Lingual nerve injury


1
Lingual nerve injury
  • Dept.of OMFS
  • Gachon Medical School
  • Gil Medical Center
  • Kim Hyeon Min

2
Prescription
  • Anatomy
  • Morphology Factors
  • Influence
  • Classification
  • Treatment
  • Conclusion
  • Reference

3
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)

4
???? 2/3 tongue lower lingual gingivaemouth
floor ?? ??,??facial N? ??? chorda tympanic N?
2/3 tongue ??? ?? by ??? 2000 ?
5
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6
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

7
Factors
  • ?????
  • ??? ?? ? ?????
  • ??? ?? ?
  • ??
  • ???? ???? ??
  • ???? ??? ???? ??
  • ?? ??? preparation? bur? disc? ??
  • ????
  • By Jacks?(1998),Griffiths?(1
    999), etc

8
Patterns of furcation of LN IAN
  • Type I 65.6
  • Type II 25.0
  • Type III 3.1
  • Type IV 6.3
  • -??? 2? ??? ????? ???? ??? ? ??

9
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?
    ????

10
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

11
Cross sectional morphology
  • Retromolar 3rd molar 2nd
    molar
  • Mx diameter 2.3mm 3.3mm 3.0mm
  • -???? ? ??? ????? ????? ???
  • -CTN? LN ?? ??? ?? ???? ????? ??? ????? ?? ?? ???
    ???? ??? ???

12
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? ?? ??

13
Crossing of LN SMD
  • 2nd molar(D) 40.8 3rd molar(mid) 37
  • -SMD(submandibular duct)? ??? mouth floor
    surgery? ????? ?? ??? ?? ???? ?? ??? ???.

14
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

15
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

16
Influence by LN injury
  • Tongue ant. 2/3 ?? ?? ??
  • ??? ?? ????? ??
  • -LN? ????? ???? ????? ??? ????? ??? ?? ????
    ?????? ??? ????? ??? ??? ??. By Himmelfarb (1985)

17
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)

18
(No Transcript)
19
(No Transcript)
20
Diagnosis
  • 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??

22
Treatment
23
(No Transcript)
24
(No Transcript)
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

28
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

29
  • Non sutured nerve repair
  • -fibrin sealant? ????? ????? ?? ??

30
??? ????? ??? ? ????
  • 1)???? ?? ? ? 4??
  • 2)???? ?? 12?? observation
  • ? 2/3 ???? ???
  • ? ?? ????? ???? ???? ?? surgical approach
  • 3)Prognosis
  • Intraoral approach difficulty
  • ??? ?? ??? ??? ??
  • ???? ???? ????? ??

31
Conclusion
  • ??????? 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
  • ??? ?? ???? ??

33
Reference
  • ???? ????? ? ??? ?? ??? ?? ??? ?? ??? ??-?? ?
    ?? ?? ??.?????????????? 25114-121,2003
  • ???????? ???
  • ??? ??????? ??? ? ? ??, ??? ????????? 2003 .4
  • ??????? ???? ?? ? ????.?????????? 27118,2001

34
  • Thank you for your attention !!!
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