Management of inferior alveolar nerve and lingual nerve injuries in the UK - a cross-sectional study.

Post operative nerve injury following mandibular third molar (M3M) potentially impacts a significant number of patients. A lack of consensus for the management of trigeminal nerve injuries exists. It is important to know how clinicians manage these injuries, and how confidently. A 16-question online survey using SurveyMonkey was developed and sent to all current UK members of three oral srelated societies (ABAOMS, BAOS and BAOMS) from January 2021 to March 2021. The survey consisted of open free text, binomial and variable scale responses related to the management of inferior alveolar nerve and lingual nerve injuries. A total of 158 clinicians responded to the survey. The average number of M3M removed monthly over the last three years by a clinician was 25. The average number of nerve injuries seen in a clinician's practice, within the last three years, was three. Over two-thirds of respondents were only somewhat confident, not so confident, or not at all confident in the management of patients with inferior alveolar nerve (IAN) and lingual nerve (LN) injury. In occurrence of an injury, only 45% stated they would make an onward referral and a minority of clinicians had access to surgical repair within their own unit. Free text responses highlighted themes of a lack of UK awareness of management interventions and pathways for these patients. Clear national guidance on managing trigeminal nerve injuries was a commonly desired theme from responding clinicians. Joint speciality partnerships and a national nerve repair registry is now required.

Changing trends in the microvascular reconstruction and oral rehabilitation following maxillary cancer.

PURPOSE: The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of this study is to report on how the method of reconstruction and oral rehabilitation of the maxilla has changed since 1994 in our Institution, and to reflect on case mix and survival. METHODS: Consecutive head and neck oncology cases involving maxillary resections over a 27-year period between January 1994 and November 2020 were identified from hospital records and previous studies. Case note review focussed on clinical characteristics, reconstruction, prosthetic rehabilitation, and survival. RESULTS: There were 186 patients and the tumour sites were: alveolus for 56% (104), hard palate for 19% (35), maxillary sinus for 18% (34) and nasal for 7% (13). 52% (97) were Brown class 2 defects. Forty-five patients were managed by obturation and 78% (142/183) had free tissue transfer. The main flaps used were radial (52), anterolateral thigh (27), DCIA (22), scapula (13) and fibula (11). There were significant changes over time regarding reconstruction type, use of primary implants, type of dental restoration, and length of hospital stay. Overall survival after 24 months was 64% (SE 4%) and after 60 months was 42% (SE 4%). CONCLUSION: These data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants.