Assessing nerve injuries in oral surgery: a survey-based study on prevention and management

Abstract

Background: Understanding and mitigating iatrogenic nerve injuries, specifically IAN and LN, is crucial in the field of oral and maxillofacial surgery. These injuries may lead to profound sensory deficits, pain syndromes, and impaired quality of life for patients. This study aims to assess the prevention and management practices for inferior alveolar nerve and lingual nerve injuries among dental professionals. By gathering data through a survey, the study seeks to evaluate current experiences, awareness, and protocols, ultimately contributing to improved guidelines for nerve injury management. Material and Methods: This cross-sectional study utilized an online survey distributed via Turkish Dental Association to registered dentists and specialists. The predictor variables were the procedure types associated with nerve injuries. The main outcome variables were preventive measures and patient management strategies. Demo-graphic profiling including age, years in profession, specialty, and type of current workplace were determined as covariates. Results: 1477 respondents provided complete answers, with questions addressing demographics, nerve injury incidents, preventive measures, and management strategies. The most reported IAN and LN injuries were linked to dental implant surgery (n=1067), mandibular third molar surgery (n=958), and local anesthesia applications (n=459). Interestingly, more than 30% of participants reported no experience with nerve injuries. For preventive measures in tooth extraction, 281 respondents performed coronectomies, and in implant surgery over 80% of the participants evaluated tomographic images in high-risk cases. Most common management strategies for paresthesia included vitamin B12 (n=1093) and NSAIDs (n=1051). The use of gabapentin, and non-medical treatments like biofeedback and alternative therapies were rarely employed. Conclusions: The survey revealed a diverse range of practices regarding nerve injury prevention and management, emphasizing the need for evidence-based approaches and consensus guidelines. Understanding current practices for managing IAN and LN injuries can inform future guidelines, reduce complications, and improve patient outcomes in oral and maxillofacial surgery.