Factors influencing nerve damage during lower third molar surgery

Area of Science:

• Oral and Maxillofacial Surgery
• Anesthesiology
• Neurosurgery

Background:

• Lower third molar surgery is a common procedure with potential risks, including iatrogenic nerve damage.
• The choice of anesthetic modality may influence the incidence of nerve injury.
• Understanding risk factors is crucial for patient safety during third molar extraction.

Purpose of the Study:

• To investigate the relationship between anesthetic modality and nerve damage during lower third molar surgery.
• To explore associations between pathology, eruption status, and age with nerve damage.

Main Methods:

• A single-center prospective study involving 367 patients undergoing lower third molar removal.
• Patients were assessed for iatrogenic nerve damage (altered sensation) at 1 week post-surgery.
• Follow-up for 6 months for patients with persistent sensory alterations.

Main Results:

• 13.4% of 718 lower third molar removals resulted in altered lingual, labial, or buccal sensation.
• No significant association found between nerve damage and eruption status, age, or pre-operative pathology.
• Nerve damage incidence was significantly higher under general anesthesia (18%) versus local anesthesia (3%) (P < 0.01).

Conclusions:

• Lower third molar removal under general anesthesia is associated with a fivefold increased risk of lingual and inferior alveolar nerve damage compared to local anesthesia.
• This increased risk cannot be attributed to surgical difficulty, pre-operative pathology, age, or anatomical position.