A case series of trigeminal nerve injuries caused by periapical lesions of mandibular teeth

Multislice computed tomography demonstrating mental nerve paresthesia caused by periapical infection: A case report

Components derived from an infected lesion within the bone can spread through various passages in the mandible, particularly via the mental foramen. Radiologically, the spread of infection is typically nonspecific and challenging to characterize; however, multislice computed tomography (MSCT) can effectively detect pathological changes in soft tissues and the bone marrow space. This report describes the case of a 55-year-old woman who experienced mental nerve paresthesia due to a periapical infection of the right mandibular second premolar. MSCT imaging revealed increased attenuation around the periapical lesion extending into the mandibular canal and loss of the juxtamental foraminal fat pad. Following endodontic treatment of the tooth suspected to be the source of the infection, the patient's symptoms resolved, and the previous MSCT imaging findings were no longer present. Increased bone marrow attenuation and obliteration of the fat plane in the buccal aspect of the mental foramen may serve as radiologic indicators of inflammation spreading from the bone marrow space.

Resolution of apical periodontitis-induced mental nerve paresthesia through non-surgical endodontic retreatment: a case report

INTRODUCTION

Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle.

METHODS

The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by CBCT imaging.

RESULTS

Non-surgical root canal retreatment was performed over two visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation.

CONCLUSION

Non-surgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.

Mental Nerve Paraesthesia: A Report of Two Cases Associated with Endodontic Etiology

Paraesthesia of the mental nerve can occur due to various etiological factors. Rarely, dental infections can cause paraesthesia. However, this article discusses two cases of endodontic etiology in the mental nerve region as a causative factor for paraesthesia. In the first case, the patient had severe pain localized to his right mandible, with numbness of his lower lip. Endodontic treatment led to quick regression and resolution of paraesthesia. In the second case, a patient who was referred for retreatment of a mandibular second premolar infection developed profound paraesthesia in the region of the mental nerve distribution following prior therapy. Possible mechanisms responsible for periapical infection-related paraesthesia are discussed here. CBCT imaging may be useful in the diagnosis and management of such conditions.

Risk Factor in Endodontic Treatment: Topographic Evaluation of Mandibular Posterior Teeth and Lingual Cortical Plate Using Cone Beam Computed Tomography (CT)

Background

Topographic relationships of mandibular posterior teeth with mandibular cortical plate are extremely important both in terms of infection spread and endodontic and surgical procedures to be performed. The aim of this study was to determine the relationship between root apex of the mandibular posterior teeth and lingual plate of the mandible.

Material/Methods

CBCT data of 138 patients were retrospectively analyzed. The topographic relationship between root apex and lingual plate was classified as non-contact, contact, or perforation. Morphology of the mandibular lingual plate was classified into the 4 types (convex, parallel, undercut, slanted) and recorded for each tooth region. The prevalence of each group was calculated.

Results

In 6.2% of all mandibular posterior teeth, the lingual plate was perforated by at least 1 root of the corresponding tooth. The teeth with the highest perforation rate were the third molar tooth (31.6%) and the second molar tooth (14.7%). The most common mandibular lingual plate morphology type was “undercut type” (61.3%) in the molar teeth region, while “parallel type” (55.7%) was most common in the premolar teeth region.

Conclusions

In conclusion, a high percentage of mandibular second and third molars root apex have topographically close relationships to the lingual plate of the mandible. Hence, endodontic consultants must be aware by this anatomical relationship and be aware of possible complications during endodontic and surgical procedures using radiographical modalities.

Objective Assessment of Lingual Nerve Microsurgical Reconstruction

Lingual nerve (LN) injury is one of the most serious consequences of oral surgery. Prompt microsurgical reconstruction of the nerve can alleviate most of those symptoms leading to satisfactory functional recovery.Thirty-five patients with partial to complete LN injury underwent surgery in the period between January 2006 and May 2015. All patients underwent a preoperative clinical and neurological evaluation with the assessment of lingual tactile and pain sensory thresholds and masseteric inhibitory reflex.All patients underwent explorative surgery and direct microneurorrhaphy of distal and proximal stumps in case of complete lesion, while the removal of traumatic neuroma and the following microneurorrhaphy of distal and proximal stumps of the injured nerve was performed in case of incomplete lesion. Nerve grafting has always been avoided because of distal stump mobilization obtained by severing the submandibular branch of the LN.All patients but 1 exhibited good recovery of tongue sensation, never complete, both clinically and electrophysiologically: recovery of the excitability of masseteric inhibitory reflex suppression components SP1 and SP2 was observed, often with increased latencies but consistent with a functional recovery.All patients feeling pain preoperatively experienced complete relief of algic symptoms.The early microsurgical approach is the most suitable choice for the treatment of LN injuries.