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Do anatomical variations of the mandibular canal pose an increased risk of inferior alveolar nerve injury after third molar removal?

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Abstract

Objectives

The present study aimed to assess whether anatomical variations of the mandibular canal are associated with neurosensory disturbances of the inferior alveolar nerve (IAN) following mandibular third molar removal.

Methods

Two observers compared the detection of third molar root-nerve relations and bifurcations of the mandibular canal on panoramic radiographs and CBCT images of 201 patients undergoing removal of 357 mandibular third molars. Potential neurosensory disturbances of the IAN were surveyed ten days after surgery. Fisher’s Exact was performed to correlate presence of canal variations to postoperative neurosensory disturbances. Positive and negative predictive values (PPV, NPV) and likelihood ratios (LR + , LR–) were calculated.

Results

Thirteen patients reported postoperative altered sensation of the lower lip, with 2 of them having mandibular canal bifurcations on the ipsilateral side of the injury. Fisher’s Exact showed that the studied mandibular canal variations were not related to postoperative neurosensory disturbances. CBCT was superior in visualization of anatomical variations of the mandibular canal. Prevalence of bifurcations was 14% on CBCT and 7% on panoramic radiographs. In both imaging modalities and for all parameters, PPVs were low (0.04 − 0.06) and NPVs were high (0.92 − 0.98), with LR ranging around 1.

Conclusion

In the present study, the assessed mandibular canal variations had limited predictive value for IAN neurosensory disturbances following third molar removal.

Clinical relevance

While a close relation between the third molar and the mandibular canal remains a high risk factor, mandibular canal variations did not pose an increased risk of postoperative IAN injury after third molar removal.

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Author information

Authors and Affiliations

  1. OMFS-IMPATH Research Group, , Department of Imaging and Pathology, Faculty of Medicine, University of Leuven, and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Kapucijnenvoer 7 blok a, 3000, Leuven, Belgium

    Myrthel Vranckx, Hannah Geerinckx, Hugo Gaêta-Araujo, Andre Ferreira Leite, Constantinus Politis & Reinhilde Jacobs

  2. Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil

    Hugo Gaêta-Araujo

  3. Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil

    Andre Ferreira Leite

  4. Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden

    Reinhilde Jacobs

Authors
  1. Myrthel Vranckx
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  2. Hannah Geerinckx
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  3. Hugo Gaêta-Araujo
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  4. Andre Ferreira Leite
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  5. Constantinus Politis
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  6. Reinhilde Jacobs
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Corresponding author

Correspondence to Myrthel Vranckx.

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Ethical approval

The study was approved by the Medical Ethical Committee of the University Hospitals of Leuven (Belgium) (B322201525552). All procedures performed in this study, involving human participants, were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

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The authors declare no competing interests.

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Vranckx, M., Geerinckx, H., Gaêta-Araujo, H. et al. Do anatomical variations of the mandibular canal pose an increased risk of inferior alveolar nerve injury after third molar removal?. Clin Oral Invest 26, 931–937 (2022). https://doi.org/10.1007/s00784-021-04076-3

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