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Trigeminal Neuropathy After Mandibular Fractures

Epidemiology and Neurophysiologic Diagnosis

Joachim, Michael, DMD, MSc*; Tabib, Rami, DMD; Laviv, Amir, DMD; Pikovsky, Anna, DMD§; Zadik, Yehuda, DMD, MHA||,¶; Zeltser, Rephael, DMD

Journal of Craniofacial Surgery: June 2019 - Volume 30 - Issue 4 - p 1113–1117
doi: 10.1097/SCS.0000000000005215
Clinical Studies
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Objectives: To study the trigeminal nerve neuropathy prevalence after mandibular fractures and follow nerve recovery and to examine associations with clinical features.

Subjects: The files of 304 patients treated for 424 mandibular fractures in Hadassah Medical Center between 2001 and 2008 were analyzed. Twenty-five patients with paresthesia were examined by electro-diagnostic conduction test (quantitative sensory testing).

Results: The most common fracture sites were the symphysis (28.5%) and condyle (21.4%). A strong correlation between fracture severity and treatment modality was found. Nerve damage occurred in 13.4% of nondisplaced fractures and in 65.3% of >5 mm displaced fractures. Patients who were treated by open reduction internal fixation demonstrated the biggest difference in quantitative sensory testing values between the affected and nonaffected sides. C nerve fibers were the most damaged and least regenerated. There was correlation between damage perception and objective test results.

Conclusions: There is a correlation between fracture type and displacement severity on neurologic deficit and prognosis. The objective neurosensory damage was manifested by higher nerve excitation threshold on the injured side. Patients should be informed on the prognosis of neurologic deficit according to fracture type.

*Department of Oral and Maxillofacial Surgery, Baruch Padeh Medical Center affiliated to the Azrieli Faculty of Medicine, Bar-Ilan University, Poriya

Department of Oral and Maxillofacial Surgery, Hadassah Medical Center, Hebrew University Faculty of Dental Medicine, founded by Alpha Omega fraternity, Jerusalem

Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv

§Oral Medicine Unit, Department of Oral and Maxillofacial Surgery, Soroka University Medical Center, Beer Sheva

||Department of Oral Medicine, Sedation and Maxillofacial Imaging, Hadassah-Hebrew University School of Dental Medicine, Jerusalem

Department of Oral Medicine, The Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel Hashomer, Israel.

Address correspondence and reprint requests to Michael Joachim, DMD, MSc, Baruch Padeh Medical Center, MP Lower Galilee, Poriya, Israel 15208; E-mail: mike.joachim@gmail.com

Received 26 April, 2018

Accepted 1 November, 2018

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments.

Informed consent was obtained from all individual participants included in the study.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.