Evaluating Lingual Nerve Repair Outcomes: A Systematic Review.

PURPOSE: The lingual nerve (LN) is susceptible to injury during oral and maxillofacial procedures, leading to neurosensory deficits. Advances in microsurgical techniques necessitate a comprehensive review of overall effectiveness and influencing factors. METHODS: A systematic review was performed via Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies. Inclusion criteria were full text availability, studies written in english, and studies published after 2000 reporting LN repair. The primary outcome was sensory improvement defined via functional sensory recovery (FSR) or neurosensory testing (NST). Sex, time from injury to repair, method of repair, and graft length were examined to see if each influenced outcomes. RESULTS: A sample of 786 subjects across 17 studies was examined. Most patients were female (73.3%) and suffered injuries from third molar extractions (72.8%). Of the studies, 10 defined improvement by FSR with a total of 88.8% (500/563) of nerves achieving such. Of those achieving FSR, 91% did so within a year. The remaining 7 studies defined sensory improvement by individually setting various NST thresholds, with the combined improvement rate being 88.6% (203/229). Positive outcomes were achieved with graft lengths up to 70 mm. Results on time to repair were mixed. The methods of repairs were not different based on statistical analysis short of performing an equivalence trial. CONCLUSION: Conclusions made from studies using FSR were similar to studies using NST, meaning the method of measuring outcomes does not seem to be a confounder. FSR is the superior scale due to being objective and standardized. LN repair produced high rates of sensory improvement, which is expected to occur within 1 year postoperative. Sex and graft length did not influence outcomes. More research is needed to determine the effect of time to repair on efficacy. Most methods of repair produced similar outcomes, suggesting multiple valid techniques exist.

Assessing the Efficacy of Allogeneic Nerve Grafts in Trigeminal Nerve Repair: A Systematic Review.

PURPOSE: Our primary objective was to assess the efficacy of allogeneic nerve grafts in inferior alveolar nerve or lingual nerve repair. We hypothesized that using allogeneic nerve grafts would be effective, as evidenced by achieving high rates of functional sensory recovery (FSR). Additionally, we looked if sex, time from injury to repair, etiology of nerve damage, and graft length affected outcomes. METHODS: A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. PubMed and Scopus databases were searched using specific search strategies to generate eligible studies. Inclusion criteria encompassed studies reporting use of allogeneic grafts, assessing FSR using either Medical Research Council Scale or Neurosensory Testing, and published within the past 15 years. RESULTS: Across 10 studies conducted between 2011 and 2023, analysis was performed on 149 patients and 151 reconstructed nerves. Allogeneic nerve grafts showed an average FSR rate of 88.0%. Kaplan-Meier analysis of time to FSR postoperatively revealed that of those achieving FSR, 80% achieved it within 6 months and 98% achieved it by 1 year. The mean graft length was 29.92 mm ± 17.94 mm. The most common etiology for nerve damage was third molar extractions (23.3%). Sex distribution among patients revealed that 85 were female (57.0%) and 64 were male (43.0%). CONCLUSION: Our primary hypothesis was supported as nerve allografts achieved high rates of FSR. FSR was achieved in normative timeframes, which is 6 to 12 months postoperatively. Furthermore, allografts reduced the risk of posttraumatic trigeminal neuropathy. Time from injury to repair, graft length, etiology of nerve damage, and sex did not affect FSR. As the assessed variables in our study did not affect outcomes, there needs to be a more nuanced approach to understanding and addressing various factors influencing sensory recovery.

Both Type I Bovine Collagen Conduits and Porcine Small Intestine Submucosa Conduits Result in Functional Sensory Recovery Following Peripheral Nerve Microsurgery: A Systematic Review and Meta-Analysis.

PURPOSE: The study purpose was to measure and compare the time to functional sensory recovery (FSR) and incidence of FSR by 6 and 12 months between type I bovine collagen conduits versus porcine small intestine submucosa (SIS) conduits with primary neurorrhaphy for peripheral nerve injury repair. METHODS: A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were conducted. The predictor variable was the type of conduit-either bovine collagen or porcine SIS. The primary outcome variable was the number of months between surgery and the patient achieving FSR. The secondary outcome variable was the proportion of patients who achieved FSR that did so by 6 and 12 months. A log-rank test was performed to evaluate the statistical significance of the differences observed in the overall time-to-FSR data and by 6 and 12 months. RESULTS: We screened 67 publications of which 8 were included. The sample sizes were 137 and 96 patients for the bovine collagen and porcine SIS groups, respectively. The median time to FSR for the bovine collagen conduit group was 9 months (interquartile range: 6); the median time to FSR for the porcine SIS conduit group 6 months (interquartile range: 3 months) (P = .50). Of the patients who achieved FSR, 42% of patients with bovine collagen conduits and 64% of patients with porcine SIS conduits did so within 6 months (P < .01). Of the patients who achieved FSR, 94% of patients with bovine collagen conduits and 82% of patients with porcine SIS conduits did so within 12 months (P < .01). CONCLUSION: Although a significant difference was found in the incidence of FSR at 6 and 12 months, no significant difference was found in overall time to FSR, supporting the use of either conduit for peripheral nerve repair.

Evaluating Stromal Vascular Fraction As a Treatment for Peripheral Nerve Regeneration: A Scoping Review.

PURPOSE: This study aims to investigate the potential of stromal vascular fraction (SVF) for peripheral nerve regeneration. METHODS: A scoping review of Scopus and PubMed databases was conducted. Inclusion criteria were human or animal studies exploring the use of SVF for peripheral nerve regeneration. Studies were categorized by assessed outcomes: pain assessment, neural integrity, muscle recovery, and functional recovery. Level of evidence and study quality were assessed. RESULTS: Nine studies met the inclusion criteria. SVF injection in humans with trigeminal neuropathic pain reduced pain scores from 7.5 ± 1.58 to 4.3 ± 3.28. SVF injection improved sensation in humans with leprosy neuropathy. Repairing transected rat sciatic nerves with SVF-coated nerve autografts improved wet muscle weight ratios (0.65 ± 0.11 vs 0.55 ± 0.06) and sciatic functional index (SFI) scores (-68.2 ± 9.2 vs -72.5 ± 8.9). Repairing transected rat sciatic nerves with SVF-coated conduits increased the ratio of gastrocnemius muscle weights (RGMW) (7-10% improvement), myelinated fibers (1,605 ± 806.2 vs 543.6 ± 478.66), and myelin thickness (5-20% increase). Repairing transected rat facial nerves with SVF-coated conduits improved whisker motion (9.22° ± 0.65° vs 1.90° ± 0.84°) and myelin thickness (0.57 µm ± 0.17 vs 0.45 µm ± 0.14 µm). Repairing transected rat sciatic nerves with SVF-coated nerve allografts improved RGMW (85 vs 50%), SFI scores (-20 to -10 vs -40 to -30), and Basso, Beatie, and Bresnahan locomotor scores (18 vs 15). All metrics mentioned above were statistically significant. The human studies were level 4 evidence due to being case series, while animal studies were the lowest level of evidence. CONCLUSION: Despite initial promising results, the low-level evidence from the included studies warrants further investigation.

Comparing 5-Fluorouracil Versus Modified Carnoy's Solution for the Treatment of Odontogenic Keratocysts: A Systematic Review and Meta-Analysis.

PURPOSE: The primary aim of this study was to compare time to odontogenic keratocyst (OKC) recurrence with 5-fluorouracil (5-FU) versus modified Carnoy's solution (MCS) following enucleation and curettage and peripheral ostectomy. The secondary aim was to compare the frequency (%) of permanent peripheral nerve injury characterized by hypoesthesia and neuropathic pain present at 12 months or more after surgery with 5-FU versus MCS. METHODS: The Cox hazard ratio was calculated to compare time to recurrence between the 2 groups. To compare the frequencies of permanent nerve damage, we fitted a fixed-effects model to the data and calculated the risk ratio. Other variables collected were sex, age, follow-up time, and cyst size. RESULTS: No significant differences in sex, age, follow-up time, and cyst size were found. The median follow-up time for all patients was 60 months (range: 12-180 months, Q1 = 32 months, Q3 = 86 months, interquartile range = 54 months). Of the 114 patients treated with MCS, 27 recurrences with a median recurrence time of 42 months (range = 12-108 months, Q1 = 26.3 months, Q3 = 54 months, interquartile range = 27.7 months) were recorded; no recurrences were observed among the 99 patients treated with 5-FU (hazard ratio = 0.02, 95% CI = 0.00018-0.16, P = 2.27e-07). Of the 112 patients treated with MCS, there were 20 (17.86%) instances of permanent peripheral nerve injury; of the 98 patients treated with 5-FU, there were 7 (7.14%) instances of permanent peripheral nerve injury (risk ratio = 0.44, 95% CI = 0.20-0.97, P = .04). CONCLUSION: The results of this meta-analysis significantly favored 5-FU over MCS for lower OKC recurrence and peripheral nerve injury, supporting the use of 5-FU as the superior adjuvant following enucleation and curettage and peripheral ostectomy for the treatment of OKCs.

Is ChatGPT an Accurate and Readable Patient Aid for Third Molar Extractions?

BACKGROUND: Artificial intelligence (AI) platforms such as Chat Generative Pre-Trained Transformer (ChatGPT) (Open AI, San Francisco, California, USA) have the capacity to answer health-related questions. It remains unknown whether AI can be a patient-friendly and accurate resource regarding third molar extraction. PURPOSE: The purpose was to determine the accuracy and readability of AI responses to common patient questions regarding third molar extraction. STUDY DESIGN, SETTING, SAMPLE: This is a cross sectional in-silico assessment of readability and soundness of a computer-generated report. INDEPENDENT VARIABLE: Not applicable. MAIN OUTCOME VARIABLES: Accuracy, or the ability to provide clinically correct and relevant information, was determined subjectively by 2 reviewers using a 5-point Likert scale, and objectively by comparing responses to American Association of Oral and Maxillofacial Surgeons (AAOMS) clinical consensus papers. Readability, or how easy a piece of text is to read, was assessed using the Flesch Kincaid Reading Ease (FKRE) and Flesch Kincaid Grade Level (FKGL). Both assess readability based on mean number of syllables per word, and words per sentence. To be deemed readable, FKRE should be >60 and FKGL should be <8. COVARIATES: Not applicable. ANALYSES: Descriptive statistics were used to analyze the findings of this study. RESULTS: AI-generated responses above the recommended level for the average patient (FKRE: 52; FKGL: 10). The average Likert score was 4.36, suggesting that most responses were accurate with minor inaccuracies or missing information. AI correctly deferred to the provider in instances where no definitive answer exists. Of the responses that addressed content in AAOMS consensus papers, 18/19 responses closely aligned with them. All prompts did not provide citations or references. CONCLUSION AND RELEVANCE: AI was able to provide mostly accurate responses, and content was closely aligned with AAOMS guidelines. However, responses were too complex for the average third molar extraction patient, and were deficient in citations and references. It is important for providers to educate patients on the utility of AI, and to decide whether to recommend using it for information. Ultimately, the best resource for answers is from the practitioners themselves because the AI platform lacks clinical experience.

Outcomes of Direct Lingual Nerve Repair After an Injury: A Systematic Review.

PURPOSE: The purpose of this study was to conduct a systematic review with meta-analysis to investigate the outcomes of direct lingual nerve repair after injury. MATERIALS AND METHODS: The studies in this review were compiled by using PubMed/Medline and ScienceDirect, which were searched by a single reviewer (M.K.) from their inception until March 10, 2020. Two independent reviewers (M.K. and V.B.Z.) who were blinded to each other's assessments reviewed full-text articles to assess for study inclusion. Outcomes were dichotomized as either functional sensory recovery (FSR) or no FSR. Clinical testing must have been assessed at a minimum of 6 months postoperatively. FSR was defined as grade S3, S3+, or S4 on the British Medical Research Council scale of neurosensory function. Studies were only eligible if they provided the number of patients treated with conduits or time from injury to repair and the associated rates of FSR with each intervention. RESULTS: The initial search using the key terms yielded 4,921 results, which was then eventually filtered down to 6 articles after multiple levels of appraisal. Five articles were retrospective cohort studies and 1 was a randomized controlled study. Four of the 6 studies reported an FSR of grade S3 or higher in 85% or more of the patients. Conduit use was not associated with a significantly greater likelihood of achieving FSR (pooled risk ratio = 1.10; 95% confidence interval, 0.96 to 1.27; P = .17). Repair within 6 months was associated with significantly improved likelihood of achieving FSR (pooled risk ratio = 0.84; 95% confidence interval, 0.71 to 0.99; P = .04). CONCLUSIONS: The use of conduits during repair was not associated with clinically significant increased FSR. Early repair was associated with a beneficial effect on FSR; however, heterogeneity was an issue with the studies. There is a lack of strong evidence owing to the nature of studies analyzed and the need for further research is required.

Use of Virtual Surgical Planning as an Adjunct for Enucleation of Multiple Recurrent Odontogenic Keratocysts: Case Report.

This case report describes an interesting use of virtual surgical planning to fabricate tooth-borne cutting guides to assist in localization and enucleation of multiple recurrent odontogenic keratocysts close to the inferior alveolar nerve. The 3-dimensional models generated and cutting guides increased the accuracy and precision of the procedure and decreased surgical time and potential patient morbidity.

Efficacy of Acellular Nerve Allografts in Trigeminal Nerve Reconstruction.

PURPOSE: During trigeminal nerve repair, a gap is sometimes encountered that prevents the tension-free apposition of nerve endings. The use of a processed acellular nerve allograft is a novel technique that shows promise in overcoming this problem. The goal of the present study was to support the slowly evolving body of evidence that acellular processed nerve allografts (Avance; Axogen, Alachua, FL) are a viable alternative to autogenous nerve grafting and the use of conduits for reconstructing defects of the trigeminal nerve. PATIENTS AND METHODS: The study design consisted of a retrospective review of the medical records of patients referred to Rutgers School of Dental Medicine for management of trigeminal nerve injuries from July 2008 to August 2014. Sixteen patients met the inclusion criteria for the present study. All patients underwent nerve grafting using a processed nerve allograft. All operations were performed by the same surgeon (V.Z.). Serial neurosensory testing was performed by 1 clinician (V.Z.) in a standardized fashion. The primary outcome variable was the interval to functional sensory recovery as defined by the Medical Research Council Scale. RESULTS: The participants ranged in age from 16 to 62 years (mean 32). Of the 16 patients, 12 were female (75%) and 4 were male (25%), and 3 were smokers (18.75%) and 13 were nonsmokers (81.25%). One half of the patients (n = 8; 50%) underwent surgery on the inferior alveolar nerve, and 8 (50%) underwent surgery on the lingual nerve. The most common mechanism of injury was impacted third molar removal (n = 9; 56.25%) Of the 16 patients, 15 (93.75%) achieved functional sensory recovery during the study period. CONCLUSIONS: The results of the present study support the hypothesis that processed nerve allografts are effective in reconstructing small (<2-cm) trigeminal nerve defects.

Lingual Nerve Microsurgery Outcomes Using 2 Different Conduits: A Retrospective Cohort Study.

PURPOSE: This study compared a type 1 collagen conduit (NeuraGen) with a porcine small intestinal submucosa conduit (AxoGuard) when used in lingual nerve microsurgery and any differences in achieving functional sensory recovery (FSR). PATIENTS AND METHODS: All patients who underwent lingual nerve microsurgery performed by 1 surgeon (V.B.Z.) from 2007 to 2014 had their surgical information obtained by a retrospective review of hospital records and office charts after institutional review board approval. Those patients whose surgery included the use of a nerve conduit were included in the study. Subjective neurosensory recovery was determined by neurosensory testing, including responses to hot, cold, wisp, brush, and pinprick. Objective recovery was determined by testing 2-point discrimination and fine touch threshold with von Frey fibers. The objective findings were correlated to a Medical Research Council System score, with grades S3, S3+, and S4 indicating FSR. RESULTS: The conduits were compared using a Student t test with a 2-tailed hypothesis. The von Frey fiber test had a preoperative mean of 6.29 (standard deviation [SD], 0.95), which improved to 3.97 (SD, 0.67) for the NeuraGen and 4.17 (SD, 0.56) for the AxoGuard. Two-point discrimination improved from a mean higher than 19.42 to 9.32 mm (SD, 2.96 mm) for the NeuraGen and 9.67 mm (SD, 2.13 mm) for the AxoGuard. The mean FSR was S3+. CONCLUSIONS: There were no meaningful differences in outcomes between the 2 conduits studied, and all patients achieved FSR according to the Medical Research Council Scale.

Use of Fibrin Glue as an Adjunct in the Repair of Lingual Nerve Injury: Case Report.

This report describes a case of lingual nerve injury repair using a novel technique in which Tisseel fibrin glue was used to stabilize an Axoguard nerve conduit placed around the site of primary neurorrhaphy to decrease the number of sutures required for stabilization. Five months postoperatively, the patient subjectively had increased sensation and improved taste in the left lingual nerve distribution. At neurosensory examination, the patient exhibited functional neurosensory recovery (S3+ on the Medical Research Council Scale).

Role of Collagen Conduit With Duloxetine and/or Pregabalin in the Management of Partial Peripheral Nerve Injury.

PURPOSE: The objective of this study was to investigate the analgesic effect of a collagen conduit (Neuragen, Integra LifeSciences Corp, Plainsboro, NJ) using duloxetine (Cymbalta, Lilly, Indianapolis, IN) with or without pregabalin (Lyrica, Pfizer, NY) on pain induced by partial sciatic nerve transection in a rat model. MATERIAL AND METHODS: Adult male Sprague-Dawley rats were divided into 5 groups (n = 10 per group): group 1, nerve damage with no treatment; group 2, nerve damage treated with the application of a collagen conduit and saline; group 3, nerve damage treated with the application of a collagen conduit and duloxetine; group 4, nerve damage treated with the application of a collagen conduit and pregabalin; and group 5, nerve damage treated with the application of a collagen conduit and pregabalin plus duloxetine. Pain levels were evaluated by responses to mechanical and thermal stimuli at baseline before and 3 and 7 days after surgery. Interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF) levels were evaluated in blood, sciatic nerve, and dorsal root ganglion samples collected 7 days after surgery. RESULTS: The group treated with the collagen conduit and pregabalin exhibited markedly less pain 7 days postoperatively in response to mechanical and thermal stimuli compared with the other groups. IL-10 levels were considerably increased in the group treated with pregabalin. The groups treated with a collagen conduit and duloxetine and a combination of pregabalin and duloxetine also exhibited markedly less pain in response to mechanical and thermal stimuli 7 days after surgery compared with the group that had only nerve injury. The decrease in pain using duloxetine was not as robust but was associated with a decrease of TNF-α. The combination of pregabalin and duloxetine resulted in a substantial decrease in IL-6. CONCLUSION: Using a collagen conduit and duloxetine, pregabalin, and their combination helped alleviate neuropathic pain. The mechanism of action might be associated, at least in part, to cytokines.

Impact of COVID-19 on emergency oral health care in New Jersey.

BACKGROUND: The COVID-19 pandemic led to reduced services of private dental practices. The public emergency clinic of Rutgers School of Dental Medicine (RSDM) (Newark, NJ) faced changing demands during various periods of the pandemic. METHODS: Records of patients visiting the emergency clinic at RSDM during 3 distinct periods (prelockdown, lockdown, teledentistry) from January 10, 2020, through June 30, 2020, were retrospectively reviewed. Qualitative and quantitative attributes pertaining to patient encounters were reviewed and analyzed. RESULTS: A total of 1,799 records were included in this study. Patient visits increased during the early lockdown but were reduced after the implementation of teledentistry. Trends were noted in patient volume, reasons for visits, treatment needs, symptoms, diagnostic methodology, prescription use, and final disposition of patients. CONCLUSIONS: The lockdown affected emergency dental clinic services at RSDM. Teledentistry visits played a key role in screening patients and in facilitating the delivery of oral health care and timely follow-ups to patients who needed urgent in-person emergency visits. PRACTICAL IMPLICATIONS: Data gathered will lead to a better understanding of patients seen in the emergency clinic and can help with long-term planning for both institutional and smaller outpatient clinics during public health emergencies.

Systemic Factors Affecting Healing in Dentistry.

Healing process in the oral cavity is influenced by a range of systemic factors. More specifically, patient health status, medications, habits, and nutritional state play crucial roles in dental healing. Additionally, the body's immune response, inflammation, and overall well-being are key determinants in wound repair. Understanding these systemic factors is essential for dental professionals to optimize patient care, minimize complications, and achieve successful healing.

Training satisfaction versus dissatisfaction among chief residents in oral and maxillofacial surgery--a pilot survey.

PURPOSE: To survey chief residents in accredited oral and maxillofacial surgery (OMS) training programs to assess their satisfaction with their surgical training and analyze their career plans after residency. MATERIALS AND METHODS: A 19-question anonymous survey was electronically mailed to 212 individuals identified as graduating chief residents in accredited OMS training programs. RESULTS: Ninety-four individuals (44%) completed the survey. Of these 85 were men (90.4%) and 9 were women (9.6%). Average age was 32 years. Forty-seven respondents (50%) completed the 4-year traditional OMS programs, 37 respondents (39.4%) completed the 6-year MD integrated programs, 9 respondents (9.6%) completed the 4-year MD option programs, and 1 listed "other" as a program type. Fifty-two individuals (55.3%) planned a full-time private practice career, 5 (5.3%) planned a full-time academic career, 3 (3.2%) planned a military career, 27 (28.7%) planned a combined private practice and academic career, and 7 (7.4%) planned to complete a fellowship after residency. Seventy-nine of all respondents (84%) were satisfied with their OMS training program, whereas 15 (16%) were not. CONCLUSION: Most participants of this survey were satisfied with their training program and OMS as a career. However, it is important to note that less than half (44%) of chief residents who received this survey completed it. This short survey is a pilot survey; a more involved evaluation of OMS resident satisfaction is planned, further assessing satisfaction and burnout during residency.

Dental student perceptions of oral and maxillofacial surgery as a specialty.

PURPOSE: The specialty of oral and maxillofacial surgery (OMS) encompasses the diagnosis and surgical management of a variety of pathologic, functional, and esthetic conditions of the oral and maxillofacial region. Despite the specialty's prominent role in the field of dentistry, a lack of complete understanding still remains among dental and medical health professionals as to the exact scope and expertise of the oral and maxillofacial surgeon. The present study aimed to analyze a population of dental students' perceptions of OMS as a specialty with respect to treatment rendered, referral patterns, and a general opinion of the specialty as a whole. MATERIALS AND METHODS: A survey consisting of 10 multiple-choice questions was compiled and distributed to dental students through an on-line polling service (SurveyMonkey). A total of 5 dental student classes at a single dental school were polled using school-based electronic mail, including the graduating seniors. All answers were kept confidential, and no individual students were identified. The students were not able to retake the survey once completed. The final tallies of the survey results were compiled and submitted for statistical analysis. RESULTS: Statistically significant associations between the year of dental education and student perceptions of OMS were determined. As dental students progress through their undergraduate studies, their perceptions change with regard to the referral of dental implants. Periodontists were found to have statistically significantly greater rates of referral than oral and maxillofacial surgeons from dental students in the fourth year and recent graduates compared with younger dental students from the first, second, and third years for placement of dental implants. Statistically insignificant in terms of a changing dental student perception was the finding that third molar removal was within the domain of the oral and maxillofacial surgeon, as well as the management of cleft lip and palate deformities and mandibular fracture repair. Almost all the dental classes believed that the specialty of OMS was both medical and dental in nature and that it is a very important dental specialty. CONCLUSIONS: Dental student perceptions of OMS change throughout their undergraduate training. The reasons for such a change are multivariate and might include factors such as the amount of didactic training and clinical exposure. It is vital to both recognize and address this change at an undergraduate level of training in an effort to increase educated referrals to a surgeon who might provide the best treatment options for the patient. A stronger understanding of the dental students' perception of OMS provides an opportunity for the oral and maxillofacial academic faculty to better educate students and, ultimately, strengthen our specialty.

Interval between injury and lingual nerve repair as a prognostic factor for success using type I collagen conduit.

PURPOSE: The purpose of the present study was to investigate the role of a type I collagen nerve conduit in the repair of lingual nerve injuries compared with those lingual nerve repairs performed without a collagen membrane and to identify the prognostic factors for functional sensory recovery (FSR). MATERIALS AND METHODS: This was a retrospective cohort study evaluating a sample derived from the population of patients who had undergone lingual nerve microsurgery from March 17, 2000, to February 23, 2010 by the same surgeon (V.B.Z.) with complete records available, including follow-up assessments. The primary outcome variable was the interval to successful FSR according to the British Medical Research Council criteria for FSR. The predictor variables were categorized into demographic, surgical, and clinical sensory testing. Appropriate descriptive statistics and univariate and multivariate Cox proportional hazards survival statistics were computed in analyzing the patient age at lingual nerve injury repair (in years), gender, timing of surgical intervention, mechanism of injury, specific surgical procedures, and application of a type I collagen conduit. RESULTS: The study cohort included 41 patients with 42 lingual nerve injuries who underwent surgical repair. Their mean age was 28.3 ± 8.3 years (range 13 to 44), with 88% females (n = 32). In the multivariate model, the injury to surgery interval per 1-month increase (hazard ratio 1.23, 95% confidence interval 1.02 to 1.48, P = .029) and injury to surgery interval of 9 months or longer (hazard ratio 4.67, 95% confidence interval 1.04 to 20.87, P = .04) remained significantly associated statistically with successful FSR. CONCLUSIONS: The results of the present study have demonstrated that the injury to surgery interval is the most significant prognostic factor in the repair of lingual nerve injuries. The use of the collagen membrane demonstrated a greater level of FSR compared with those treated without the use of the membrane. However, the results from the collagen conduit were not statistically significant.

Is there a role for a collagen conduit and anti-inflammatory agent in the management of partial peripheral nerve injuries?

PURPOSE: The purpose of this study was to investigate the effect of a collagen conduit and an anti-inflammatory agent in the treatment of acute partial sciatic nerve injuries in a rat chronic constrictive injury (CCI) model. MATERIALS AND METHODS: Adult male Sprague-Dawley rats were divided into 5 groups: group 1 (nerve damage with no treatment), group 2 (nerve damage and collagen tube), group 3 (nerve damage and collagen tube treated with anti-inflammatory agent), group 4 (sham surgery), and group 5 (naive rat). Each group consisted of 10 study animals. The nerve injury model used was the CCI model. Behavioral responses to thermal and mechanical stimuli were tested at 3, 7, and 14 days after surgery. Transverse sections of nerve tissue were harvested at day 14 and evaluated by standard error of mean (SEM). RESULTS: Tactile allodynia measurements showed initial increases in the threshold at day 3, followed by a significant decrease at day 7, and consistently remained lower than baseline by day 14. Heat allodynia measurements at day 3 showed a statistically significant decrease in threshold compared with the CCI group. However, at days 7 and 14, the threshold was not statistically different from the CCI group threshold. Groups with and without anti-inflammatory agents at day 7 showed a statistically significant decrease in threshold to both heat and tactile allodynia from day 3, indicating that groups with collagen and anti-inflammatory treatment had significant decreases in both heat and tactile allodynia. A similar relationship was observed at day 14. Transverse sections of nerve tissue evaluated by SEM of nerve tissue revealed a broad distribution of axons in group 1, with the greatest interaxonal distance in cross sections. Group 2 displayed less interaxonal distance compared with group 1, and group 3 had the least interaxonal distance. CONCLUSIONS: This study demonstrated a statistically significant decrease in pain secondary to the application of a collagen conduit and anti-inflammatory agent. Behavioral testing and SEM data also support the finding of a decrease in edema in the presence of a collagen conduit, with the greatest decrease being in the presence of both collagen conduit and anti-inflammatory agent.

Temporomandibular Disorders: Surgical Implications and Management.

Temporomandibular disorders are a group of conditions that interfere with the daily lives of patients. Pain and limited function are primary concerns, and general dentists are usually the primary clinicians to be made aware of this issue. Evaluation and diagnosis is the key to determining a management plan. Minimally invasive surgical treatment includes arthrocentesis and arthroscopy, which can reduce inflammatory mediators, thereby reducing pain and increasing joint function. Open joint surgery for internal derangements focuses on instrumentation to remove and reshape the diseased condyle and disc as arthroplasty. Patients with severely limited function are candidates for total joint replacement.

A combination of hyaluronic acid filler, subnasal lip lift, chemical peel, and onabotulinum toxin A superiorly reestablishes perioral esthetics: a case report.

With increasing age and edentulism, numerous esthetic changes occur to the perioral region. The upper lips lose definition, flatten, and lengthen, the cupid's bow is lost, and the oral commissures descend. The nasolabial folds deepen, marionette lines become prominent, vertical rhytids around the lips form, and chin rhytids form. Chronic exposure to UVA radiation from the sun can lead to photodamage, characterized by wrinkles, lentigines, actinic keratoses, and other pigment changes. In addition, edentulism leads to jaw atrophy, which often compromises soft tissue support. Removable dentures, the conventional treatment to restore missing teeth, not only replace teeth, but also provide support to the lips via the labial flange. Implant-supported fixed prostheses are a very popular option to restore completely edentulous arches; these prostheses are flangeless, providing no bulk to the lips. Addressing changes in the perioral region due to aging and edentulism requires a combination of treatments, with each addressing different issues. Onabotulinum toxin A can be used to treat dynamic perioral and chin rhytids, and upturn the corners of the mouth. Hyaluronic acid filler can be used to treat deep nasolabial folds, marionette lines, and re-volumize the lips. Chemical peels can treat photodamaged skin, static rhytids, and other dermatologic pathologies. The subnasal lip lift, developed by Cardoso and Sperli in 1971, has become an increasingly common technique used to rejuvenate the upper lip in elderly and edentulous patients. This case report describes an elderly patient who was treated with a combination of subnasal lip lift, hyaluronic acid filler, onabotulinum toxin A, and chemical peel to achieve superior perioral esthetics. This case highlights the synergy of each procedure when done in combination to achieve highly effective results.