• Journal of Dental Rehabilitation and Applied Science
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• v.19 no.2
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• pp.109-113
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• 2003

The inferior alveolar nerve provides unilateral innervation to the dentition, labial mucosa and skin from about commissure to the mental protuberance. Injury to this nerve resulting in sensory impairment can be a distressing problem to some patients. The causes of this problem include trauma, extraction, implant surgery and any maxillofacial surgery and generally the altered sensation is temporary. The surgical procedure has been the most common treatment for this condition but it has some complications. The antidepressants and anticonvulsants have been effective to the treatment of trigeminal dysesthesia. This case report suggests that the use of antidepressants and anticonvulsants is an alternative method to treat the paresthesia after implant surgery or extraction.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.16-21
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• 2011

Background: Since introduced by Gow-Gates GA in 1973, Gow-Gates mandibular nerve block (GMNB) has played an important role in the area of dental local anesthesia. However, compared to the conventional inferior alveolar nerve block (IANB), this technique seems to fail to attract the attentions of general practitioners in South Korea. The aim of this study was to prove the clinical real value, mainly the anesthetic efficacy, of GMNB in minor oral surgery. Methods: The study group comprised 40 patients (15 males and 25 females) who were randomly allocated to receive GMNB or IANB for extraction of third molars. Both techniques utilized two 1.8 ml dental cartridges of 2% lidocaine including 1:100,000 epinephrine for each patient. Pulpal and gingival tissue anesthesia of mandibular premolars and molars were recorded at 0, 15 and 40 minutes after administration of local anesthetics using both an electric pulp tester and a sharp dental explorer. Results: The success rates of pulpal and gingival tissue anesthesia in the IANB group were not significantly different from the GMNB group in overall efficacy. Patient's and operator's satisfaction ratings were also not significantly different between two groups. Interestingly, the injection pain of GMNB group was significantly lower than that of IANB group. Conclusion: This study demonstrated that the anesthetic efficacy of pulpal and gingival tissue of GMNB was not inferior to that of IANB. The GMNB could be a good alternative of the IANB in most of minor oral surgical procedures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.41 no.2
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• pp.74-77
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• 2015

Objectives: Transpositioning of the inferior alveolar nerve to prevent injury in lower jaw has been advocated for orthognathic, pre-prosthetic and for implant placement procedures. However, the concept of infra-orbital nerve repositioning in cases of mid-face fractures remains unexplored. The infraorbital nerve may be involved in trauma to the zygomatic complex which often results in sensory disturbance of the area innervated by it. Ten patients with infraorbital nerve entrapment were treated in similar way at our maxillofacial surgery centre. Materials and Methods: In this article we are reporting three cases of zygomatico-maxillary complex fracture in which intra-operative repositioning of infra-orbital nerve into the orbital floor was done. This was done to release the nerve from fractured segments and to reduce the postoperative neural complications, to gain better access to fracture site and ease in plate fixation. This procedure also decompresses the nerve which releases it off the soft tissue entrapment caused due to trauma and the organized clot at the fractured site. Results: There was no evidence of sensory disturbance during their three month follow-up in any of the patient. Conclusion: Infraorbital nerve transposition is very effective in preventing paresthesia in patients which fracture line involving the infraorbital nerve.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.38 no.4
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• pp.231-239
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• 2012

Objectives: This study sought to provide guidelines in order to decrease the incidence of nerve injury during mandibular ramus bone harvesting, and to improve understanding of the anatomical structure of the inferior alveolar canal (IAC) to include its distance from the exterior buccal cortex. Materials and Methods: In January and February 2009, 20 patients who visited the Wonkwang University Department of Oral and Maxillofacial Surgery reporting various conditions underwent cone beam computed tomography and were included in this study. Patients with missing left or right mandibular first molars or incisors, or who had jaw fracture or bone pathologies, were excluded. The reference point (R point) was defined as the point where the occlusal plane reached the anterior ramus of the mandible. The position of the IAC in relation to the R point, the buccal bone width (BW), the alveolar crest distance (ACD), the distance from the alveolar crest to the occlusal plane (COD), and the distance from the IAC to the sagittal plane (CS) were determined using proprietary image analysis software which produced cross-sectional coronal and axial images. Results: The distance medially from the R point to the IAC along the axial plane was $6.19{\pm}1.21mm$. The HD from the R point, posteriorly to IAC, in the lateral view was $13.07{\pm}2.45mm$, the VD from the R point was $14.24{\pm}2.41mm$, and the ND from the R point was $10.12{\pm}1.76mm$. The pathway of the IAC was positioned almost in a straight line along a sagittal plane within $0.56{\pm}0.70mm$. The distance from the buccal bone surface to the IAC increased anteriorly from the R point. Conclusion: Marking osteotomy lines in the retromolar area in procedures involving bone harvesting should be discouraged due to the risk of damage to IAC structures. Our measurements indicated that the area from the R point in the ramus of the mandible to 10 mm anterior can be safely harvested for bone grafting purposes.

• Restorative Dentistry and Endodontics
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• v.17 no.1
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• pp.1-9
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• 1992

The intradental nerve activity was recorded from single pulp nerve unit dissected from the inferior alveolar nerve in canine teeth of anesthetized cats. The effects of various test solutions on intradental nerve activity evoked by 4M NaCl applied to the deep dentinal cavities were investigated. 1. Total 15 single pulp nerve units were recorded. Of these 9 were Mi - fibers and 6 were C -fibers. The mean conduction velocity and electrical threshold of $A{\delta}$ - fiber were $6.3{\pm}3.7m/sec$, $1.2{\pm}0.7V$ and those of C - fiber were $1.0{\pm}0.2m/sec$, $2.3{\pm}1.3V$, respectively. The response to cold stimuli of $A{\delta}$ - fiber began immediately and that of C - fiber began after a latency. 2. When applied to deep dentinal cavity, 4M NaCl induced irregular bursts of action potential in 4 $A{\delta}$ - fibers and 3 C - fibers, which continued until the solution was washed away. 3. In the $A{\delta}$ - fiber, histamine failed to induce any nerve acitivity and did not produce an increase in intradental nerve activity evoked by 4M NaCl. However following the application of 1M KCl, the response to 4M NaCl was eliminated. 4. In the C - fiber, histamine generated some nerve activity and produced a significant increase in intradental nerve activity evoked by 4M NaCl, but 5M $CaCl_2$ did not abolish this enhandced response.

• Journal of Oral Medicine and Pain
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• v.38 no.3
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• pp.255-260
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• 2013

Bilateral sagittal split ramus osteotomy(BSSRO) of the mandible is an essential and commonly used procedure to correct dentofacial deformities and malocclusion. The possible complications associated with BSSRO include inferior alveolar nerve injury, bleeding, temporomandibular disorder, unfavorable fractures, and clinical relapse. The incidence of facial nerve palsy after orthognathic surgery recently reported is 0.1%. The probable etiologies have included facial nerve compression, complete or incomplete nerve transection, nerve traction, and nerve ischemia from anesthetic injection. Postoperative facial palsy is one of the most serious complications because it reduces the quality of life and significantly reduces social interaction. The case of a 24-year-old patient who underwent bilateral sagittal split ramus osteotomy is described. The medical records and postoperative photographs were reviewed in detail to collect information on the clinical course, treatment, and outcomes.

• Imaging Science in Dentistry
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• v.49 no.3
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• pp.213-218
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• 2019

Purpose: The aim of this study was to evaluate the relationship between the mandibular canal and impacted mandibular third molars using cone-beam computed tomography (CBCT) and to compare the CBCT findings with signs on panoramic radiographs(PRs). Materials and Methods: This retrospective study consisted of 200 mandibular third molars from 200 patients who showed a close relationship between the mandibular canal and impacted third molars on PRs and were referred for a CBCT examination of the position of the mandibular canal. The sample consisted of 124 females and 76 males, with ages ranging from 18 to 47 years (mean, $25.75{\pm}6.15$ years). PRs were evaluated for interruption of the mandibular canal wall, darkening of the roots, diversion of the mandibular canal, and narrowing of the mandibular canal. Correlations between the PR and CBCT findings were statistically analyzed. Results: In total, 146 cases(73%) showed an absence of canal cortication between the mandibular canal and impacted third molar on CBCT images. A statistically significant relationship was found between CBCT and PR findings (P<0.05). The absence of canal cortication on CBCT images was most frequently accompanied by the PR sign of diversion of the mandibular canal(96%) and least frequently by interruption of the mandibular canal wall(65%). Conclusion: CBCT examinations are highly recommended when diversion of the mandibular canal is observed on PR images to reduce the risk of mandibular nerve injury, and this sign appears to be more relevant than other PR signs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.39 no.6
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• pp.263-268
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• 2013

Objectives: The interforminal region, between the mandibular foramen, is known as a relatively safe area that is free of anatomic structures, such as inferior alveolar nerve, submandibular fossa, and lingual side of the mandible is occasionally neglected for its low clinical importance. Even in the case of a severely constricted alveolus, perforation of the lingual cortical bone had been intended. However, anterior extension of the inferior alveolar canal, important anatomic structure, such as concavity of lingual bone, lingual foramina, and lingual canal, has recently been reported through various studies, and untypical bleeding by perforation of the lingual plate on implantation has also been reported. Therefore, in this study, we performed radiographic and statistical analysis on distribution and appearance frequencies of the lingual foramina that causes perforation of the mandibular lingual cortical bone to prevent complications, such as untypical bleeding, during surgical procedure. Materials and Methods: We measured the horizontal length from a midline of the mandible to the lingual foramina, as well as the horizontal length from the alveolar crest to the lingual foramina and from the lingual foramina to the mandibular border by multi-detector computed tomography of 187 patients, who visited Dankook University Dental Hospital for various reasons from January 1, 2008 to August 31, 2012. Results: From a total of 187 human mandibles, 110 (58.8%) mandibles had lingual foramina; 39 (20.9%) had bilateral lingual foramen; 34 (18.2%) had the only left lingual foramen; and 37 (19.8%) had the only right lingual foramen. Conclusion: When there is consistent bleeding during a surgical procedure, clinicians must consider damages on the branches of the sublingual artery, which penetrate the lingual foramina. Also, when there is a lingual foramina larger than 1 mm in diameter on a pre-implantation computed tomography, clinicians must beware of vessel damage. In order to prevent these complications and progress with a safe surgical procedure, a thorough radiographic examination before the surgery is indispensable. Further, clinicians should retract lingual flap definitely to confirm the shape of the lingual bone and existence of the lingual foramina.

• Restorative Dentistry and Endodontics
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• v.20 no.2
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• pp.527-537
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• 1995

The effect of calcitonin gene-related peptide (CGRP), substance P (SP) and electrical stimulation of the tooth on the intradental nerve activtiy (INA) was investigated in anesthetized cats. The INA was recorded from single pulp nerve units dissected from the inferior alveolar nerve under stereomicroscope. The INA elicited by 3 minute application of 4M NaCl in deep dentinal cavity was compared before and after stimulation at 10 minute intervals. The magnitude of INA was calculated as the total number of nerve impulses produced in given period, and the changes of INA are expressed as % of control INA. The results obtained were as follows. 1. 16 single pulp nerve units were classified as 14 $A{\delta}$-fibers (3.4~19.4m/sec) and 2-fibers (1.5~1.7m/sec) according to the conduction velocity. 2. 4M NaCl evoked an irregular bursts of spikes which continued until washing out. Isotonic saline did not affect INA to subsequent applications of the hypertonic NaCl solution (P>0.05). 3. Local application of CGRP ($200{\mu}g$/ml) in deep dentinal cavity reduced the INA induced by 4M NaCl in $A{\delta}$-fiber units (P<0.01) and some units of those responded to CGRP during application. 4. Local application of SP ($100{\mu}g$/ml) in deep dentinal cavity reduced the INA induced by 4M NaCl in AS-fiber units (p<0.05), but increased the INA in C-fiber unit coincided with large reduction of the INA of $A{\delta}$-fiber units. 5. Monopolar electrical stimulation applied to the crown at intensities high enough to excite C-fibers (12V, 5ms, 10Hz, 10~30min) decreased the INA in $A{\delta}$-fiber units (P<0.01) and systemic pretreatment with phenoxybenzamine (3mg/kg, i.v.) enhanced this inhibitory effect (P<0.01). On the contrary, electrical stimulation increased the INA in C-fiber unit.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.38
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• pp.25.1-25.4
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• 2016

Background: Bilateral sagittal split ramus osteotomy (BSSRO) is the most widely used mandibular surgical technique in orthognathic surgery and is easy to relocate the distal segments, accelerating bone repair by the large surface of bone contact. However, it can cause neurosensory dysfunction (NSD) or sensory loss by injury of the inferior alveolar nerve. The purpose of the present study was to evaluate NSD after BSSRO and modifiers at NSD recovery. Methods: In this study, NSD characteristics after BSSRO from 2009 to 2014 at the Kyung Hee University Dental Hospital were evaluated. The pattern of sensory recovery over time was also evaluated based on factors such as field of sensory dysfunction, surgical procedure, presence of pre-operative facial asymmetry, and postoperative medications. Results: Most of the patients had shown NSD immediately after orthognathic surgery. Among the 1192 sides of 596 patients, NSD was observed in 953 sides and 544 patients. Sexual predilection was shown in males (p value = 0.0062). In the asymmetric group of 132 patients, NSD was observed in 128 patients (96.97 %). In the symmetric group of 464 patients, NSD was observed in 416 patients (89.45 %); on the other hand, NSD was observed significantly higher in the asymmetric group (p = 0.025). NSD-associated factors were analyzed, and vitamin B12 may be beneficial for NSD recovery. Conclusions: There was a difference between the symmetric group and the asymmetric group in NSD recovery. Vitamin B12 can be regarded as an effective method to nerve recovery. However, a further prospective study is needed.