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Background:
Review

Therapy of Neurophysiological Changes after Oral and Maxillofacial Surgery—A Systematic Review

by
Amely Hartmann
1,2,*,
Jörg Schmohl
3,
Lorena Cascant Ortolano
4,
Oliver Bayer
5,
Stefanus Schweizer
4,
Claudia Welte-Jzyk
6,
Bilal Al-Nawas
2 and
Monika Daubländer
2
1
Department of Oral Surgery, Echterdinger Straße 7, 70794 Filderstadt, Germany
2
Department of Oral and Maxillofacial Surgery, University Medical Centre of the Johannes Gutenberg University of Mainz, 55131 Mainz, Germany
3
Department of Internal Medicine, Diakonie Hospital Stuttgart, Rosenbergstr. 38, 70176 Stuttgart, Germany
4
Departmental Library for the University Medical Centre, Johannes Gutenberg University of Mainz, 55122 Mainz, Germany
5
Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg University of Mainz, 55131 Mainz, Germany
6
Department of Neurology, University Medical Centre of the Johannes Gutenberg University of Mainz, 55131 Mainz, Germany
*
Author to whom correspondence should be addressed.
Appl. Sci. 2022, 12(3), 1507; https://doi.org/10.3390/app12031507
Submission received: 6 December 2021 / Revised: 18 January 2022 / Accepted: 24 January 2022 / Published: 30 January 2022
Browse Figures
Versions Notes

Abstract

:
Introduction: The purpose of this systematic review was to critically analyze the recent literature to present a guideline for management of neurophysiological changes after implant placement and oral and maxillofacial surgical procedures. Materials and methods: Three electronic databases and manual search approaches were used to identify relevant articles on neurophysiological changes. Only studies with a randomized controlled study design were included. Primary outcome was defined as the status of recovery and relief of pain states under various therapies. Two independent reviewers evaluated the data. Results: A total of eight studies from 2891 records identified met the inclusion criteria. Therapy options for patients with neurophysiological changes after implant placement and oral and maxillofacial surgery were low-level laser (LLL), stellate ganglion block (SGB), medication, and surgical removal of implants. Six studies dealt with LLL, providing a significant improvement in mechanical sensation. Only one study revealed the whole neurosensory profile including neuropathic pain states. All the included RCT studies presented at least one bias, and a considerable heterogeneity of the included studies was revealed. Conclusions: Reduced thermal sensation may be due to irritation of small fibers. LLL might help to improve nerve recovery.

1. Introduction

Oral and maxillofacial surgical procedures are part of everyday routine in modern dentistry. Removal of wisdom teeth, implant placement, root resection, orthodontic surgical intervention or periodontic treatment are well-established and well-documented procedures. Literature offers a wide range of opportunities to provide an adequate reduction of pain, trismus, and swelling in the acute postoperative phase. These temporary problems are typical side effects of the surgical treatment and will resolve normally within a few days. In general, it is important to differ between sensitive nerve impairment and traumatically caused nerve injury. The first mentioned may develop without an injury of anatomically relevant structures and has a high spontaneous remission rate.
Unfortunately, surgical interventions may go along with some severe and long-lasting postsurgical complications [1,2]. In implant therapy, it is the leading cause of litigation and patients’ complaint. Neurosensory disturbances of the trigeminal nerve represent such a severe complication [3,4]. The inferior alveolar nerve is known to be the nerve most commonly traumatized (64%), followed by the lingual nerve (28.8%) [5]. Traumatic local injections [6,7] or poor surgical procedures [8] are known to cause nerve injury [9]. The incidence of inferior alveolar nerve injury (IANI) shows a wide range in literature from 0 to 40% in implant dentistry [5,10,11,12,13,14,15,16,17,18]. Lingual nerve injury (LNI) [19,20,21] is the most common injury associated with third molar removal. In addition to sensory disturbances, alterations in taste perception may occur [22].
Altered sensation may be transient or permanent. A proper early neurophysiological testing, including subjective and objective techniques [23,24,25,26] and also new diagnostic methods [27,28], is obligate. Delayed clinical diagnosis may result in inefficient treatment results [29]. Clinical appearance can vary between a mild paresthesia, or an anesthesia accompanied by severe neuropathic pain [16,30,31]. Patients’ quality of life is affected [32] and iatrogenic nerve injuries represent a major cause of claims against the surgeon [33]. Therefore, avoidance of nerve lesions should be the primary goal of each treatment. Although established treatment methods for neurosensory disturbances are missing, literature offers some recommendations mainly based on follow-ups of nerve recovery [34] and case series [35,36].
The aim of this article was to critically review the recent literature to present a profound guideline for management of neurophysiological changes after implant placement and oral and maxillofacial surgical procedures.

2. Materials and Methods

The review protocol has been registered on PROSPERO (hyperlink, CRD42018114483). This review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols (PRISMA-P 2015 [37]).

2.1. Eligibility Criteria

Original articles were selected based on the PICO (Population Interventions Comparison Outcomes) criteria (Table 1):
Population: Participants included in this review were adults (>18). All of them had undergone oral and maxillofacial surgical procedures with consecutive neurophysiological disturbances of the trigeminal nerve. Alteration must be assessed by neurophysiological diagnostic tools (quantitative sensory testing/QST, neurosensory testing, minimal measurement such as two-point discrimination/needle sensation). Subjective findings, such as visual analogue scale/VAS or index-related findings, had to be documented. The sensory changes were defined as altered sensation (hypoesthesia, hyperesthesia, anesthesia, paresthesia, dysesthesia, pain).
Interventions: All participants underwent interventions to improve their sensory disturbances, such as medical therapy (steroids, vitamin B, others) or surgical interventions (nerve reconstruction, laser therapy). Adverse effects were considered.
Comparison: Improvement in sensation after various interventions was compared to no treatment (time management) or placebo.
Outcomes: Primary outcome was defined as the status of recovery (complete/partial and residual sensory disturbances such as hypoesthesia, hyperesthesia, anesthesia, paresthesia) and relief of pain states under various therapies. It was defined as the proportion of the number of patients who showed significant/complete recovery compared to the general population of the included studies. The intention was to show the superiority of a therapy for nerve injury after surgical procedures.
Secondary outcome was defined as the status of no recovery. It was labeled as the proportion of the number of patients who showed no improved altered sensation compared to the general population of the included studies.

2.2. Searches

The search methods included database searching and manual searching techniques. A search strategy was developed and tested in the databases to be searched. The strategy used both controlled vocabulary (e.g., MeSH) and free-text searching.
Three electronic databases were searched: MEDLINE (via PubMed), CENTRAL (via the Cochrane Library) and Science Citation Index Expanded (via Web of Science) (Table 2 and Table 3). Only studies with a randomized controlled study design were included. Searches were conducted on 25 May 2019 and updated on 28 October 2020. All references identified by the searches were exported into EndNote (EndNote X8, Thomson Reuters, New York, NY, USA) prior to deduplication.
Additionally, a manual search was performed (reference list from previous reviews and several dental journals were searched manually; especially those specialized in periodontal and oral/maxillofacial surgery).

2.3. Study Selection

The search was carried out by two independent reviewers (JS and AH), primarily according to the title and abstract of the selected articles. Decisions were made by a consensus between the authors. Articles were sorted using Endnote (Thomas Reuters, New York, NY, USA) and screened in Microsoft® Excel® Office 365 MSO (16.0.12527.20170). Case reports, case series, technical notes, review articles, and epidemiological studies were excluded. Animal studies were not considered, as well as papers only providing histological data or papers only describing therapy/diagnostic options without involving patients. Articles with a neurosensory deficit but not because of oral and maxillofacial surgery were also excluded. Only articles with a controlled study design (involving at least a control side or/and a control group) were considered.

2.4. Data Syntheses

After initial screening, printed full text of the included studies was retrieved. The following data items were manually extracted:
Demographic and clinical characteristics (nine items) including the study design (final check-up), number of patients (total and by each sex), number of patients in control group without affection (total and by each sex), number of patients in control group with affection (total and by each sex), mean age patient group, mean age control group, surgical procedure, therapy, control group.
Methodological characteristics (seven items) reporting patients’ neurophysiological affection, pain, timepoint of measurement, assessment of alteration, area of treatment, treatment modality and start/beginning of therapy.
Outcome of neurophysiological changes (seven items) was described as complete recovery, partial (still neurophysiological changes), and none. Relief of pain or none was evaluated. The area most affected, duration of recovery/till final measurement, and patient’s subjective improvement were analyzed.

2.5. Risk of Bias and Quality Assessment

Risk of bias and quality assessment was presented according to Higgins and Altman [38] and Cochrane Collaboration’s [39] tool for assessing risk of bias.

3. Results

3.1. Results of Search and Study Selection

The searches resulted in 2695 citations and, additionally, 14 articles from manual search were retrieved. After the removal of duplicates, a total of 1756 records were screened at title and abstract stage, identifying 25 articles for full-text screening. A total of 1731 records did not meet inclusion criteria (see Methods, definition of excluding articles). (Figure 1). After update in 2020, an additional 182 papers (after duplicate removal 155) were included in title and abstract screening. Full-text screening in general yielded eight articles that fulfilled the previously described requirements for this review and were included in quantitative synthesis.

3.2. Study Characteristics

3.2.1. Demographic and Clinical Characteristics

In Table 4, demographic and clinical characteristics are presented. A total of 224 patients underwent surgery and, in total, 164 affected patients (gender data and age not available in all studies) were evaluated.
Patients underwent surgical procedures such as orthognathic surgery (bimaxillary surgery (n = 10), mandibular setback (n = 34), mandibular advancement (n = 6)), oral surgery (mandibular osteotomy (n = 7), extraction of 38 (n = 4), third molar osteotomy (n = 49), dental implant placement (n = 17), bone augmentation (n = 26)), trauma (fractured mandible (n = 2)) or local anesthetic injection (n = 4), or “other”, such as apical resection (n = 24). There were 11 different reasons for sensory disturbances; 10 were described properly.
Therapy options for patients with neurophysiological changes after oral and maxillofacial surgery were low-level laser (LLL/photobiomodulation), stellate ganglion block (SGB), medication, and surgical removal of implants. Six papers (with 72 patients included) discussed a therapy option of neurophysiological changes with LLL. From these, four are recently published (2020 [41], 2018 [42], 2018 [43], and 2013 [44]), possibly reporting a trend in therapy. Affected patients were compared to a control group with or without affection. The contralateral, unaffected side was accepted as control side with the same patients [41,44,45] and various treatment modalities [46]. Comparison to therapy was performed with placebo-LLL (five studies), no treatment (one study) and one not reported (NR). Definition of patients, case groups, control groups, and affected persons varied.

3.2.2. Methodological Characteristics

The neurophysiological changes were presented with various descriptions as defined before. In one study, pain was evaluated [46] to provide a differentiation between neurophysiological changes and nerve injury.
Alteration was assessed by objective means in the sense of quantitative sensory testing (six studies), objective neurosensory testing [41,47], and minimal measurement in the sense of two-point discrimination and needle sensation (each in one study). Subjective findings were documented in six studies (visual analogue scale for sensory disturbances in four studies, index-related in one study, and simple description of patients in one study). Timepoint of measurement and start/beginning of therapy varied from directly after surgery (day 0) to two years after surgery. If localized therapy was chosen, the area of treatment varied depending on the site of neurophysiological changes, such as chin, lip, or oral mucosa.

3.2.3. Outcome of Neurophysiological Changes

Therapy outcome is evaluated in Table 5, concerning the primary outcome of the study being defined as the status of recovery (complete/partial) under various therapies. The intention was to show the superiority of a therapy method for neurophysiological changes after surgical procedures. Reporting was difficult due to the various diagnosis mechanisms, locations, and different definitions of neurophysiological changes and their recovery. The same is true with the secondary outcome, representing the status of no recovery.
The six studies dealing with LLL reported a significant remission rate. Three studies distinguished between recovery of thermal and mechanical parameters. Not all parameters recovered to the same extent (complete/significant recovery for mechanoreceptor [42,45,48]; thermal recovery partial [42,48] or none [45]). The study [46] reporting the presence of pain described an improvement after therapy. Only in one study [49] did the authors distinguish the improvement dependent on the severity of injury caused by implants. One study [42] described the area most affected in the case group and the placebo group.
Two studies reported a subjective significant improvement after therapy compared to the placebo group; one study documented a subjective earlier recovery in the SGB therapy group. Four studies did not report on this subject. Duration of recovery/documented values until measurement ranged from one week to one year follow-up.

3.3. Risk of Bias and Quality Assessment

Figure 2 provides an overview of the results of the risk of bias analysis of the eight included studies. There is no division of the different studies, so the rate of the respective evaluations within an assessment domain is obvious.
All the included RCT studies presented at least one bias and a considerable heterogeneity of the included studies was revealed. In total, three of the seven studies received an overall rating of “critical risk of bias” due to at least one domain with a critical risk of bias. A moderate risk of bias was identified for three other studies. While not a single study is characterized by a low risk of bias overall, two studies were evaluated by a moderate to low risk of bias in summary. They represent the studies with the highest internal validity.
In the assessment domain “selective reporting (reporting bias)”, none of the included studies showed a low risk of bias.
Most of the studies were rated with a low risk of bias in the sub-item “blinding of outcome assessors” (five of seven studies).
The domain “other bias” was difficult to assess overall. This could be because two studies were assessed with an unclear risk of bias due to the lack of information, and four were assessed with a high risk of bias.

4. Discussion

Most of the studies in literature dealing with neurophysiological changes after surgical procedures are based on reports of practitioners [50,51]. Daily routine with lingual and inferior alveolar nerve disturbances is described. The intention of this review was to present an objective superiority of a therapy for functional nerve deficits after surgical procedures according to the defined primary and secondary outcomes.
Primary outcome was defined as the status of recovery under various therapies. Most of the patients experienced complete/significant recovery from altered sensation. If recovery occurred, it was not sufficient for all modalities, as already described in literature for thermal parameters [26]. Reduced thermal sensation with sensible plus signs may be due to irritation of small fibers (representing A: delta- and C: fiber-mediated stimuli [52,53]). As thermal tests showed significantly altered thresholds compared to control side and to healthy individuals, this can be an expression of a sensory deficit of these fibers. These findings were also described by Renton et al. [54] in patients after iatrogenic injury of the tongue to hot and cold stimuli. Thermal hypoesthesia (and hypoalgesia, which was not evaluated in the studies included in this review) is known to be part of neuropathic pain states [55,56,57].
In this review, the superiority of LLL as a standard therapy for nerve injury could not be shown. Although this technique seems to be the technique most promising, treatment modalities (therapies varied in mW, diameter spot size, and energy density) and assessed outcomes significantly differ. The results must be interpreted carefully. The outcome in these studies varied between 100% recovery and only incomplete remission of neurophysiological disturbances without relating it to various degrees of impairment. In analogy, these heterogenous data also lead to an imprecise characterization of the secondary outcome, which was defined as the status of no recovery. Only a tendency to provide LLL to patients with neurophysiological changes may be revealed. This is according to Mirzaie et al. [58], who showed that LLL radiation can help to rehabilitate patients with inferior alveolar nerve neuropathy occurring due to SSO (sagittal split osteotomy) surgery. They also emphasized the need for reliable studies with reproducible settings.
Although clinical routine after sensory disturbances frequently involves VitB supplementation or application of corticosteroids, this review showed no significant superiority of these factors. Only two of the included studies [18,46] involved medical treatment with different protocols without delivering better results than the other studies. Alternatives such as SGB [59] are used in cases with complex regional pain syndromes. This technique is described in the study of Nogami et al. [46], revealing a whole neurosensory profile including neuropathic pain conditions. This technique seems to be promising, although impractical in daily routine because of its high risk of side effects, several contraindications, and strongly suggested image-guided approach [60], although evidence of sympatico-related effect could not be shown yet.

4.1. Limitations of the Work

In general, due to the huge heterogeneity of the studies of surgical procedures, as well as in diagnosis, timepoint of diagnosis, and measurement of nerve lesions, conclusions from this review should be carefully interpreted.
The surgical procedures ranged from extraction of mandibular teeth in four cases [48] to mandibular advancement procedures in six patients [42]. Degree of nerve impairment and potential to recover was not related to a surgical procedure. Other factors not clearly declared in the studies were factors such as expertise of surgeon (experienced surgeon, surgeon in training, student) or anatomic individualities causing persistent neuropathic pain. These factors, as well as male gender, older age, and root curvature, were found to be risk factors for paresthesia in third molar removal [61]. Only one study dealing with neurophysiological changes and implant placement met the final inclusion criteria.
In this review, the different time points of reevaluation (e.g., after 2 years in Khullar et al. [45], 1 week after surgery [46], directly after surgery in Esmaeelinejad et al. [42]) prevent a correct comparability because of the known time impact of nerve injuries [62]. Colin et al. [63] described that persisting functional nerval disorders exceeding one year are of poor prognosis. Shavit and Juodzbalys [29] recommended an early diagnosis within the first 36 h after injury. As a clinical implication, it is necessary to emphasize the need for early referral and intervention when nerve injuries occur [63,64]. In the study of Khullar et al. [45], revealing neurophysiological disturbances of >2 years, LLL provided a significant improvement concerning sensory perception compared to placebo-LLL. This may point to potential procedures capable to improve long-term nerval disturbances, although thermal parameters did not recover after >2 years.
The studies, in general, did not differ between sensory nerve impairment and traumatically caused nerve injury. As described in the introduction, the first mentioned may develop without an injury of anatomically relevant structures and has a high spontaneous remission rate. In literature, altered sensation was found to be associated with pain in 45% of the cases [26]. Therefore, to evaluate a whole neurosensory profile, the neurophysiological changes and their correlation with neuropathic pain must be described [26,65]. Only one study [46] evaluated pain states and their potential to recover. Patients’ subjective assessment of the situation was analyzed in six studies [18,41,42,43,45,46] but not in comparable ways. This is necessary to deliver a whole reproducible profile of neurophysiological disturbances. Studies providing standardized quantitative sensory testing, including a standardized thermode, investigating cold and warm detection thresholds using the methods of limits are able to provide information on neurophysiological disorders (Khullar et al. [45], Esmaeelinejad et al. [42], Khullar et al. [48]). Some of the studies use the contralateral, unaffected side as reference, others use identical areas at a healthy control group. By using the contralateral side as a control, one may argue that patient-specific errors may occur [41]. The studies did not specify the “recovery” precisely and homogenously (e.g., four studies performing QST after therapy and involving objective measurements such as neurometry). Others identified the neurophysiological changes according to clinical findings [44]. The interpretation of the outcome, even stated as significantly improved, “seemed” not to be reliable. This concerns primary and secondary outcome as well. There is also a considerable heterogeneity concerning evaluation of IANI or LNI [41].

4.2. Future Research Directions

Future studies should aim to create real comparable control groups matched in age, gender, and origin of sensory disturbances. A standardized quantitative sensory testing [26] as a valid diagnostic tool for neurophysiological disturbances should be provided. These studies should involve more patients, structured methodologies, and should prove a superiority of one method to enhance recovery of altered sensation after surgical procedures. This will be difficult because neurosensory disturbances occur as a complication of surgical procedures. This causes ethical considerations in creating reproducible settings.
The studies should focus on thermal impairment as well. Special therapy regimes adapted to the kind of disturbance and severity would be favorable.
In days of major complaints and litigation, it is necessary to highlight the indications for surgical procedures needed in general. A former investigation showed that over half of the patients did not have a clear clinically-based indication for third molar surgery [66]. In the studies being part of this review, no publication defined a clear indication for surgical procedures. One might speculate that all indications were set according to the common guidelines.

5. Conclusions

Effective therapeutic regimes to boost nerve recovery after lingual and inferior alveolar neurophysiological changes caused by implant placement and oral and maxillofacial surgical procedures are still missing. The aim of this review was to provide such a guideline based on high-level literature. This review failed to deliver this information due to the heterogeneity of the studies. It can be assumed that LLL might help to improve nerve recovery. A stringent treatment protocol is missing. Further research based on RCTs with higher number of patients is needed. Effective therapeutic regimes to boost nerve recovery after lingual and inferior alveolar neurophysiological changes caused by implant placement and oral and maxillofacial surgical procedures are still missing. LLL might help to improve nerve recovery and reduce neuropathic pain.

Author Contributions

A.H.: Contributed to conception, design, validation, data interpretation, writing original draft; J.S.: Contributed to data interpretation, drafted, and critically revised the manuscript; L.C.O.: Contributed to design, validation, software, formal analysis, drafted manuscript, critically revised the manuscript; O.B.: Contributed to resources, drafted manuscript, critically revised the manuscript; S.S.: Contributed to design, resources, data curation, drafted manuscript, critically revised the manuscript; C.W.-J.: Contributed to conception and design, data interpretation, drafted manuscript, and critically revised the manuscript; B.A.-N.: Contributed to design, validation, critically revised the manuscript; M.D.: Supervision, contributed to conception and design, data interpretation, drafted manuscript, and critically revised the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethics Approval and Consent to Participate

This is a systematic review. Due to the character of the study no approval by the local ethics committee was necessary (Regulatory of the ethic committee of Rhineland-Palatinate and described in Gaus et al. [67]). No administrative permissions and/or licenses were acquired by the team to access the data used in the research due to the character of the study. Therefore, no written informed consent was obtained from patients.

Acknowledgments

We thank Klaus Hartmann, for paper proofing.

Conflicts of Interest

The authors declare no conflict of interest.

Abbreviations

LLLLow-level laser
SGBStellate ganglion block
RCTRandomized controlled trial
LNILingual nerve injury
IANIInferior alveolar nerve injury
PROSPEROProspective Register of Systematic Reviews
PRISMA-PPreferred Reporting Items for Systematic Review and Meta-Analysis Protocols
PICOPopulation Interventions Comparisons Outcomes
NLMNational Library of Medicine
MeSHMedical subject heading
VitBVitamin B
VASVisual analogue scale
QSTQuantitative sensory testing
JSJörg Schmohl
AHAmely Hartmann
NRNon-reported

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Applsci 12 01507 g001 550
Figure 1. PRISMA flow diagram [40].
Figure 1. PRISMA flow diagram [40].
Applsci 12 01507 g001
Applsci 12 01507 g002 550
Figure 2. Risk of bias.
Figure 2. Risk of bias.
Applsci 12 01507 g002
Table
Table 1. Definition of PICO (Population/Interventions/Comparisons/Outcome).
Table 1. Definition of PICO (Population/Interventions/Comparisons/Outcome).
PopulationInterventionsComparisonOutcomesStudy Design
Adults (>18) with neurophysiological changes after oral and maxillofacial surgery• Steroids (Prednisolone)
• Various medical interventions (e.g., VitB)
• Surgical interventions (reconstruction of nerves)
• Others
CAVE adverse effects		• No treatment (time)
• Placebo		• Recovery (complete/residual. Type of neurosensory disorder in residual cases: paresthesia, allodynia, hypoesthesia, hyperesthesia, anesthesia)
• No recovery: still neurosensory disorder(to be defined either by the patients or neurophysiological diagnostic tools)		• only RCTs
Table
Table 2. Search databases.
Table 2. Search databases.
Database (Provider)Data SearchedDate Range/Database UpdateItems Found
CENTRAL
via Cochrane Library (Wiley)		25 May 2019Issue 5 of 12 May 20191462
Science Citation Index Expanded
via Web of Science (Clarivate Analytics)		25 May 20191945–present351
MEDLINE
via PubMed (NLM)		25 May 20191996–present882
Total including duplicates2695
Total without duplicates1756
Update 25 May 2019–28 October 2020 including duplicates+182
Update 25 May 2019–28 October 2020 without duplicates+155
Table
Table 3. Detailed search strategy in CENTRAL.
Table 3. Detailed search strategy in CENTRAL.
#1((Dental NEXT Implant OR (Dental NEXT Prosthes?)):ti,ab,kw OR [mh “Dental Implants”]
#2(((Maxillofacial OR Oral) NEXT Surger) OR Exodontic):ti,ab,kw OR [mh “Surgery, Oral”]
#3((Wisdom NEXT T??th) OR (Third NEXT Molar)):ti,ab,kw OR [mh “Molar, Third”]
#4(“Operative Dentistry”):ti,ab,kw OR [mh “Dentistry, Operative”]
#5(apicoectom):ti,ab,kw OR [mh Apicoectomy]
#6(gingivectom):ti,ab,kw OR [mh Gingivectomy]
#7(gingivectom):ti,ab,kw OR [mh Gingivectomy]
#8(glossectom):ti,ab,kw OR [mh Glossectomy]
#9((Maxillomandibular NEXT Fixation) OR (“Jaw Fixation” NEXT Techni)):ti,ab,kw OR [mh “Jaw Fixation Techniques”]
#10(“Mandibular Advancement”):ti,ab,kw OR [mh “Mandibular Advancement”]
#11((Implantation NEAR (Maxillofacial NEXT Prosthes))):ti,ab,kw OR [mh “Maxillofacial Prosthesis Implantation”]
#12((Preprosthetic OR “Oral Surgical”) NEXT Procedur):ti,ab,kw OR [mh “Oral Surgical Procedures, Preprosthetic”]
#13((Alveolar OR Mandibular OR Maxillary) NEXT (Ridge NEXT Augmentation)):ti,ab,kw OR [mh “Alveolar Ridge Augmentation”]
#14(Alveolectom):ti,ab,kw OR [mh Alveolectomy]
#15(Alveoplast):ti,ab,kw OR [mh Alveoloplasty]
#16(Vestibuloplast):ti,ab,kw OR [mh Vestibuloplasty]
#17((“Maxillary Sinus” OR Sinus) NEXT (Floor NEXT Augmentation)):ti,ab,kw OR [mh “Sinus Floor Augmentation”]
#18(Tooth NEXT Extraction):ti,ab,kw OR [mh “Tooth Extraction”]
#19(Tooth NEXT (Reimplantation OR Replantation)):ti,ab,kw OR [mh “Tooth Replantation”]
#20[2-#19]
#21((“Light Touch” OR Somatosensory OR “Somatic Sensation” OR Proprioceptive OR “Pain Sensation” OR “Thermal Sensation” OR “Pinprick Sensation”) NEXT (Disorder OR Diminished)):ti,ab,kw OR [mh “Somatosensory Disorders”]
#22((Allodynia OR Hyperalges) NEXT (Primary OR Tactile OR Thermal OR Secondary OR Mechanical OR Sensation)):ti,ab,kw OR [mh Hyperalgesia]
#23((Hyperesthe OR Oxyesthesias) NEXT (Thermal OR Tactile OR Sensation)):ti,ab,kw OR [mh Hyperesthesia]
#24((Hypsthesias NEAR/3 (Tactile OR Thermal)) OR ((Reduced OR Impaired) NEXT Sensation) OR Numbness):ti,ab,kw OR [mh Hypesthesia]
#25(Paresthesia OR Formication OR Dysesthesia):ti,ab,kw OR [mh Paresthesia]
#26(Taste NEXT Disorder):ti,ab,kw OR [mh “Taste Disorders”]
#27(Ageusia OR Hypogeusia OR “Taste Blindness”):ti,ab,kw OR [mh Ageusia]
#28(((Altered OR Distorted) NEXT Taste) OR Parageusia OR Dysgeusia):ti,ab,kw OR [mh Dysgeusia]
#29((“Fifth Nerve” OR “Fifth Cranial Nerve” OR “Trigeminal Nerve” OR Trigeminal OR “Cranial Nerve V”) NEXT (Trauma OR Palsy OR Palsies OR Injur OR Neuropath OR Contusion OR Avulsion OR Transection)):ti,ab,kw OR [mh “Trigeminal Nerve Injuries”]
#30((Iatrogenic NEXT Disease) OR (“Hospital Acquired” NEXT Condition)):ti,ab,kw OR [mh “Iatrogenic Disease”]
#31(Postoperative NEXT Complication):ti,ab,kw OR [mh “Postoperative Complications”]
#32[26-#31]
#33#20 AND #32
#34(Therap OR Treatment):ti,ab,kw OR [mh Therapeutics]
#35#33 AND #34
Table
Table 4. Demographic and clinical characteristics.
Table 4. Demographic and clinical characteristics.
SourceDesignPatients (Total/Female/Male)Mean AgeAffected Case Group (Total/Female/Male)Control Group (Total/ Applsci 12 01507 i001/ Applsci 12 01507 i002) without AffectionControl Group (Total/Female/Male) with AffectionMean Age Control GroupSurgical ProcedureTherapyTherapy Control Group
Khullar SM, Emami B, Westermark A, Haanaes HR.RCT, DB13/9/435.78/NR/NRControl area upper lip same patients 8/NR/NR5/NR/NRNRSagittal Split Osteotomy20 LLL20 Placebo LLL
Esmaeelinejad M, Bayat MRCT, DB40/22/1826.52 ± 3.7820/11/9NR20/11/927.35 ± 3.35Mandibular setback 34 cases (85%), 6 cases (15%) mandibular advancement proceduresLLLPlacebo LLL
Khullar SM, Brodin P, Barkvoll P, Haanaes HRRCT13/NR/NRNR6/NR/NRNR7/NR/NRNRMandibular osteotomy (7), extraction of 38 (4), fractured mandible (2)20 LLLPlacebo LLL
Miloro M, Criddle TRRCT, DB28/19/939.9728/19/9NRGroup 1-8/NR/NR
Group 2-8/NR/NR
Group 3-8/NR/NR
Group 4-4/NR/NR		NRThird molar odontectomy (22), dental implant placement (1), local anesthetic injection (4), “other” (1)LLLPlacebo LLL
Gasperini G, de Siqueira IC, Costa LRRCT10/10/03010/10/0NRContralateral side/same patients30Bimaxillary surgery (Le Fort I and BSSO)LLLPlacebo LLL
Juodzbalys G, Wang HL, Sabalys G, Sidlauskas A, Galindo-Moreno PPS16/8/8 (affected)52.2 ± 8.116/8/825/13/12 36.9 ± 6.8Implant surgerySurgical (removal of implant and debris)
-Medical treatment (IV in terms of observed trauma 4 mg/mL dexamethasone, mild nerve injury 400–600 mg ibuprofen 3/d for 1 week, moderate/severe injury oral dexamethasone and/or NSAIDs, diuretics, vasodilators, B-group vitamins, antihistaminic drugs
-Complex cases antidepressants, anticonvulsants, antisympathetic agents, topical medication		NR/none
Nogami S, Yamauchi K, Shiiba S, Kataoka Y, Hirayama B, Takahashi TRCT104/54/50 (surgery)49.926/NR/NRNR1. No treatment (5/NR/NR)
2. Medication (10/NR/NR)
3. SGB (11/NR/NR)		NRGBR mesh (38/20/18, mean age 41.9), Block grafting (19/10/9, mean age 53.2), Sinus floor (47/25/22, mean age 54.6)Medication (10/NR/NR) or SGB (11/NR/NR)No treatment (5/NR/NR)
Bozkaya S, Cakir M, Tunc E, Ogutlu FRCT50/15/3538 ± 15.150/15/35NRContralateral side/same patientsNRRemoval of impacted third molar (54%), 46% split into: dental implant placement, cyst enucleation, local anesthesia injection, endodontic treatment, tooth extraction, autogenous graft operation, apical resection50 Photobiomodulation (LLL)NR/none
Table
Table 5. Outcome of neurophysiological changes.
Table 5. Outcome of neurophysiological changes.
SourceComplete/Significant RecoveryPartialNo RecoveryPain Relief Yes/NoArea Most AffectedDuration of Recovery/Until MeasurementPatients’ Subjective Improvement
Khullar SM, Emami B, Westermark A, Haanaes HRSignificant improvement in sensory perception load/“tendency” lip and chinNRNo significant improvement in thermal perceptionNR (thermal pain sensation evaluated)NRNRSignificant (VAS) compared to placebo
Esmaeelinejad M, Bayat MSignificant improvement of
two-point discrimination (case group)
contact direction (case group)		Heat and cold detection (case and control group)NRNRCase group: Vermilion of lower lip
Placebo group: median and paramedian area		1 yearSignificant compared to placebo
Khullar SM, Brodin P, Barkvoll P, Haanaes HRSignificant improvement of
mechanoreceptor sensitivity (case group, 5 patients)		Temperature threshold (case and control group) NR (thermal pain sensation evaluated)NRNRNR
Miloro M, Criddle TR7 LLL and 5 placeboNRNo significant difference/significant improvement between case/control group (8 LLL and 8 placebo)NRNR3 months till measurementNR
Gasperini G, de Siqueira IC, Costa LRFaster and close to normal on the LLL sideRecovery of both sides/faster and close to normal on the LLL side NRNR60 days: significant differences in skin sensitivity between control side and LLL sideNR
Juodzbalys G, Wang HL, Sabalys G, Sidlauskas A, Galindo-Moreno PMild injury-> significantly better after 7 days but control group still better, equal to control group after 1 monthModerate injury -> significant better after 21 days, after 3 months control group still better
Severe injury -> significant better after 21 days, still getting better after 3 months but still not good		Severe injuryNRNRMild injury -> significantly better after 7 days but control group still better, 1 month equal to control
Moderate injury->significantly better after 21 days, after 3 months control group still better
Severe injury -> significantly better after 21 days, still getting better after 3 months		NR
Nogami S, Yamauchi K, Shiiba S, Kataoka Y, Hirayama B, Takahashi T24 patients complete recovery (CPT as a reliable tool) 2 patients receiving no treatmentYesNR16 patients with NSDs after 1 month, 11 after 3 months, 4 after 6 months, 2 after 1 yearVAS increased in all patients after surgery, in SGB complete recovery earlier than in other groups
Bozkaya S., Cakir M., Tunc E., Ogutlu F.Significant improvement in neurosensory test scores, decrease in VAS scoresNRNRNRIAN > LNIAfter treatmentSignificant decrease in VAS
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Hartmann, A.; Schmohl, J.; Cascant Ortolano, L.; Bayer, O.; Schweizer, S.; Welte-Jzyk, C.; Al-Nawas, B.; Daubländer, M. Therapy of Neurophysiological Changes after Oral and Maxillofacial Surgery—A Systematic Review. Appl. Sci. 2022, 12, 1507. https://doi.org/10.3390/app12031507

AMA Style

Hartmann A, Schmohl J, Cascant Ortolano L, Bayer O, Schweizer S, Welte-Jzyk C, Al-Nawas B, Daubländer M. Therapy of Neurophysiological Changes after Oral and Maxillofacial Surgery—A Systematic Review. Applied Sciences. 2022; 12(3):1507. https://doi.org/10.3390/app12031507

Chicago/Turabian Style

Hartmann, Amely, Jörg Schmohl, Lorena Cascant Ortolano, Oliver Bayer, Stefanus Schweizer, Claudia Welte-Jzyk, Bilal Al-Nawas, and Monika Daubländer. 2022. "Therapy of Neurophysiological Changes after Oral and Maxillofacial Surgery—A Systematic Review" Applied Sciences 12, no. 3: 1507. https://doi.org/10.3390/app12031507

APA Style

Hartmann, A., Schmohl, J., Cascant Ortolano, L., Bayer, O., Schweizer, S., Welte-Jzyk, C., Al-Nawas, B., & Daubländer, M. (2022). Therapy of Neurophysiological Changes after Oral and Maxillofacial Surgery—A Systematic Review. Applied Sciences, 12(3), 1507. https://doi.org/10.3390/app12031507

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