Postoperative Paresthesia: A Spanner in the Works? Topographic Analysis of Inferior Alveolar Nerve to Predict Its Incidence Following Surgical Excision of Mandibular Third Molar-A Prospective Study.
Roshan Cherian, Soudha Hidayath, Aparna M Krishnakumari, Akshay D Shetty, U Hemavathi, Chouduri S Swaroop
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Abstract
Objective: This study aimed to analyze the relationship between impacted lower third molars (ILTMs) and the inferior alveolar nerve (IAN), identify radiographic predictors of neurosensory disturbances, and assess their impact on patients' quality of life.
Materials and methods: A prospective study was conducted on 350 patients (20-50 years) undergoing surgical extraction of ILTMs between May 2022 and May 2023. Panoramic radiographs were evaluated for seven radiographic signs based on Rood and Shehab criteria. Neurosensory deficits were assessed postoperatively on days 3 and 7, and monitored for up to one year. Quality of life was evaluated using the OHIP questionnaire. Surgical parameters, operator experience, and patient outcomes were analyzed.
Results: Postoperative neurosensory disturbances occurred in 10.9% (38/350) of patients, with 2.3% (8/350) persisting at one year. Mesioangular impactions were most common (47.4%), and radiographic features such as deflected roots and interruption of the white line were strongly associated with neurosensory deficits. Senior surgeons achieved better outcomes with fewer complications and shorter surgical times. Patients aged late 20s to early 30s had higher neurosensory disturbance rates, likely due to fully formed roots. Mental health conditions negatively influenced recovery and quality of life.
Conclusion: Panoramic radiographs are valuable for preoperative risk assessment of IAN injury during ILTM surgeries. Radiographic features, like deflected roots and white line interruption, are strong predictors of neurosensory deficits. Surgeon experience and mental health significantly impact outcomes, emphasizing the need for careful preoperative planning and psychological support. Larger, multicenter studies with advanced imaging techniques are recommended for further validation.
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