Microsurgical Repair of Inferior Alveolar Nerve Injuries Associated With Endodontic Treatment: Results on Sensory
Keith A Sonneveld1, Kristopher L Hasstedt2, Roger A Meyer3
1Private Practice, Facial and Cosmetic Surgery of Fort Worth, Fort Worth, TX; and Former Fellow, Georgia Oral & Facial Reconstructive Surgery, Atlanta, GA.
Purpose:
An uncommon, but serious complication of endodontic treatment is inferior alveolar nerve (IAN) injury warranting operative intervention for exploration, debridement, and repair. The purpose of the study was to evaluate outcomes of microneurosurgical intervention for endotontic-related IAN injuries in terms of achievement of functional sensory recovery (FSR) and pain relief and to identify factors affecting outcomes.
Methods:
A retrospective cohort study of patients who had microsurgical exploration and repair of IAN injuries sustained during endodontic therapy was performed. The primary predictor variable is time to surgery and the primary outcome variables were time to FSR, whether or not the patient regained FSR, and postoperative pain level at 12 months (1-10 on a visual analog scale). Secondary variables include intraoperative findings, surgical treatment rendered, sensory recovery, and preoperative pain level. Analyses include Kaplan-Meier estimation, Fisher exact test, 1-way and mixed-design analysis of variance, and paired t-test.
Results:
The sample included 23 patients with a mean age of 48.6 years with a female:male ratio of 20:3. Painful sensation was present in 17 (73.9%) of 23 patients at initial consultation. Mean time to surgery was 10.9 months (median 4.8 months, standard deviation = ±16.9). FSR was achieved in 10 of 21 patients at 1 year. Pain level at 1 year following surgical intervention improved from 4.86 to 2.76 (P = .001) with no effect from other variables.
Conclusions:
Surgical exploration and repair of endodontic-related IAN injuries is shown to improve neuropathic pain levels, while only delivering a modest recovery of sensory function. These injuries can be severe and debilitating and present with a variety of diagnoses and surgical findings. While this study fails to identify any particular factors affecting outcome, the data presented can help with clinician recommendations for treatment in patient-centered care.
