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Mapping out the surgical anatomy of the lingual nerve: a systematic review and meta-analysis

  • Received : 2023.04.19
  • Accepted : 2023.08.14
  • Published : 2023.08.31

Abstract

Objectives: Understanding the lingual nerve's precise location is crucial to prevent iatrogenic injury. This systematic review seeks to determine the lingual nerve's most probable topographical location in the posterior mandible. Materials and Methods: Two electronic databases were searched, identifying studies reporting the lingual nerve's position in the posterior mandible. Anatomical data in the vertical and horizontal dimensions at the retromolar and molar regions were collected for meta-analyses. Results: Of the 2,700 unique records identified, 18 studies were included in this review. In the vertical plane, 8.8% (95% confidence interval [CI], 1.0%-21.7%) and 6.3% (95% CI, 1.9%-12.5%) of the lingual nerves coursed above the alveolar crest at the retromolar and third molar regions. The mean vertical distance between the nerve and the alveolar crest ranged from 12.10 to 4.32 mm at the first to third molar regions. In the horizontal plane, 19.9% (95% CI, 0.0%-62.7%) and 35.2% (95% CI, 13.0%-61.1%) of the lingual nerves were in contact with the lingual plate at the retromolar and third molar regions. Conclusion: This systematic review mapped out the anatomical location of the lingual nerve in the posterior mandible, highlighting regions that warrant additional caution during surgeries to avoid iatrogenic lingual nerve injuries.

Keywords

Acknowledgement

The authors express their gratitude to the authors who have responded to our requests for clarification regarding the individual study data that was included in this review.

References

  1. Fagan SE, Roy W. Anatomy, head and neck, lingual nerve. In: Aboubakr S, Abu-Ghosh A, Adibi Sedeh P, Aeby TC, Aeddula NR, Agadi S, et al., eds. StatPearls. StatPearls Publishing; 2023. 
  2. Blackburn CW. A method of assessment in cases of lingual nerve injury. Br J Oral Maxillofac Surg 1990;28:238-45. https://doi.org/10.1016/0266-4356(90)90059-t 
  3. Mason DA. Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 1988;17:290-4. https://doi.org/10.1016/s0901-5027(88)80005-5 
  4. Van der Cruyssen F, Peeters F, Gill T, De Laat A, Jacobs R, Politis C, et al. Signs and symptoms, quality of life and psychosocial data in 1331 post-traumatic trigeminal neuropathy patients seen in two tertiary referral centres in two countries. J Oral Rehabil 2020;47:1212-21. https://doi.org/10.1111/joor.13058 
  5. Shawky M, Mosleh M, Jan AM, Jadu FM. Meta-analysis of the incidence of lingual nerve deficits after mandibular bilateral sagittal split osteotomy. J Craniofac Surg 2016;27:561-4. https://doi.org/10.1097/scs.0000000000002450 
  6. Gulicher D, Gerlach KL. Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Int J Oral Maxillofac Surg 2001;30:306-12. https://doi.org/10.1054/ijom.2001.0057 
  7. Hillerup S, Stoltze K. Lingual nerve injury in third molar surgery I. Observations on recovery of sensation with spontaneous healing. Int J Oral Maxillofac Surg 2007;36:884-9. https://doi.org/10.1016/j.ijom.2007.06.004 
  8. Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg 2001;59:1012-7; discussion 1017. https://doi.org/10.1053/joms.2001.25827 
  9. Gomes AC, Vasconcelos BC, de Oliveira e Silva ED, da Silva LC. Lingual nerve damage after mandibular third molar surgery: a randomized clinical trial. J Oral Maxillofac Surg 2005;63:1443-6. https://doi.org/10.1016/j.joms.2005.06.012 
  10. Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Lingual nerve damage after third lower molar surgical extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:567-73. https://doi.org/10.1067/moe.2000.110034 
  11. Berberi A, Le Breton G, Mani J, Woimant H, Nasseh I. Lingual paresthesia following surgical placement of implants: report of a case. Int J Oral Maxillofac Implants 1993;8:580-2. 
  12. Tay AB, Zuniga JR. Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg 2007;36:922-7. https://doi.org/10.1016/j.ijom.2007.03.012 
  13. Urban IA, Monje A, Lozada J, Wang HL. Principles for vertical ridge augmentation in the atrophic posterior mandible: a technical review. Int J Periodontics Restorative Dent 2017;37:639-45. https://doi.org/10.11607/prd.3200 
  14. Pippi R, Spota A, Santoro M. Prevention of lingual nerve injury in third molar surgery: literature review. J Oral Maxillofac Surg 2017;75:890-900. https://doi.org/10.1016/j.joms.2016.12.040 
  15. Lee J, Feng B, Park JS, Foo M, Kruger E. Incidence of lingual nerve damage following surgical extraction of mandibular third molars with lingual flap retraction: a systematic review and meta-analysis. PLoS One 2023;18:e0282185. https://doi.org/10.1371/journal.pone.0282185 
  16. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions version 6.3 [Internet]. Cochrane, 2022 [cited 2023 Apr 18]. Available from: https://training.cochrane.org/handbook 
  17. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71 
  18. Henry BM, Tomaszewski KA, Ramakrishnan PK, Roy J, Vikse J, Loukas M, et al. Development of the anatomical quality assessment (AQUA) tool for the quality assessment of anatomical studies included in meta-analyses and systematic reviews. Clin Anat 2017;30:6-13. https://doi.org/10.1002/ca.22799 
  19. Al-Amery SM, Nambiar P, Naidu M, Ngeow WC. Variation in lingual nerve course: a human cadaveric study. PLoS One 2016;11:e0162773. https://doi.org/10.1371/journal.pone.0162773 
  20. Al-Haj Husain A, Valdec S, Stadlinger B, Rucker M, Piccirelli M, Winklhofer S. Preoperative visualization of the lingual nerve by 3D double-echo steady-state MRI in surgical third molar extraction treatment. Clin Oral Investig 2022;26:2043-53. https://doi.org/10.1007/s00784-021-04185-z 
  21. Aljamani S, Youngson C, Jarad F, O'Neill F. Electrical stimulation to clinically identify position of the lingual nerve: results of 50 subjects with reliability and correlation with MRI. Oral Maxillofac Surg 2022;26:253-60. https://doi.org/10.1007/s10006-021-00985-5 
  22. Behnia H, Kheradvar A, Shahrokhi M. An anatomic study of the lingual nerve in the third molar region. J Oral Maxillofac Surg 2000;58:649-51; discussion 652-3. https://doi.org/10.1016/s0278-2391(00)90159-9 
  23. Benninger B, Kloenne J, Horn JL. Clinical anatomy of the lingual nerve and identification with ultrasonography. Br J Oral Maxillofac Surg 2013;51:541-4. https://doi.org/10.1016/j.bjoms.2012.10.014 
  24. Bokindo IK, Butt F, Hassanali J. Morphology and morphometry of the lingual nerve in relation to the mandibular third molar. Open J Stomatol 2015;5:6-11. https://doi.org/10.4236/ojst.2015.51002 
  25. Chan HL, Leong DJ, Fu JH, Yeh CY, Tatarakis N, Wang HL. The significance of the lingual nerve during periodontal/implant surgery. J Periodontol 2010;81:372-7. https://doi.org/10.1902/jop.2009.090506 
  26. Dias GJ, de Silva RK, Shah T, Sim E, Song N, Colombage S, et al. Multivariate assessment of site of lingual nerve. Br J Oral Maxillofac Surg 2015;53:347-51. https://doi.org/10.1016/j.bjoms.2015.01.011 
  27. Erdogmus S, Govsa F, Celik S. Anatomic position of the lingual nerve in the mandibular third molar region as potential risk factors for nerve palsy. J Craniofac Surg 2008;19:264-70. https://doi.org/10.1097/scs.0b013e31815c9411 
  28. Holzle FW, Wolff KD. Anatomic position of the lingual nerve in the mandibular third molar region with special consideration of an atrophied mandibular crest: an anatomical study. Int J Oral Maxillofac Surg 2001;30:333-8. https://doi.org/10.1054/ijom.2001.0064 
  29. Karakas P, Uzel M, Koebke J. The relationship of the lingual nerve to the third molar region using radiographic imaging. Br Dent J 2007;203:29-31. https://doi.org/10.1038/bdj.2007.584 
  30. Kiesselbach JE, Chamberlain JG. Clinical and anatomic observations on the relationship of the lingual nerve to the mandibular third molar region. J Oral Maxillofac Surg 1984;42:565-7. https://doi.org/10.1016/0278-2391(84)90085-5 
  31. Kim SY, Hu KS, Chung IH, Lee EW, Kim HJ. Topographic anatomy of the lingual nerve and variations in communication pattern of the mandibular nerve branches. Surg Radiol Anat 2004;26:128-35. https://doi.org/10.1007/s00276-003-0179-x 
  32. Kocabiyik N, Varol A, Sencimen M, Ozan H. An unnamed branch of the lingual nerve: gingival branch. Br J Oral Maxillofac Surg 2009;47:214-7. https://doi.org/10.1016/j.bjoms.2008.07.197 
  33. Mendes MB, de Carvalho Leite Leal Nunes CM, de Almeida Lopes MC. Anatomical relationship of lingual nerve to the region of mandibular third molar. J Oral Maxillofac Res 2014;4:e2. https://doi.org/10.5037/jomr.2013.4402 
  34. Miloro M, Halkias LE, Slone HW, Chakeres DW. Assessment of the lingual nerve in the third molar region using magnetic resonance imaging. J Oral Maxillofac Surg 1997;55:134-7. https://doi.org/10.1016/s0278-2391(97)90228-7 
  35. Pogrel MA, Renaut A, Schmidt B, Ammar A. The relationship of the lingual nerve to the mandibular third molar region: an anatomic study. J Oral Maxillofac Surg 1995;53:1178-81. https://doi.org/10.1016/0278-2391(95)90630-4 
  36. Shimoo Y, Yamamoto M, Suzuki M, Yamauchi M, Kaketa A, Kasahara M, et al. Anatomic and histological study of lingual nerve and its clinical implications. Bull Tokyo Dent Coll 2017;58:95-101. https://doi.org/10.2209/tdcpublication.2016-0010 
  37. Urban I, Traxler H, Romero-Bustillos M, Farkasdi S, Bartee B, Baksa G, et al. Effectiveness of two different lingual flap advancing techniques for vertical bone augmentation in the posterior mandible: a comparative, split-mouth cadaver study. Int J Periodontics Restorative Dent 2018;38:35-40. https://doi.org/10.11607/prd.3227 
  38. Appiah-Anane S, Appiah-Anane MG. Protection of the lingual nerve during operations on the mandibular third molar: a simple method. Br J Oral Maxillofac Surg 1997;35:170-2. https://doi.org/10.1016/s0266-4356(97)90557-x