Mandibular fractures are quite common facial injuries, but aetiology varies with country and age. Common treatment options are open reduction and internal fixation via an intra-oral or extra-oral incision. Nerve injury or dysfunction is often seen preoperatively and may also be a complication of surgery. One of the more common nerve injuries is postoperative hypoesthesia of the ipsilateral mental nerve following ORIF. Injury to the inferior alveolar nerve (IAN) can cause a severe reduction in the quality of life and also may cause chronic pain states. Apart from malocclusion this can be one of the more devastating effects of a mandibular fracture. It is sometimes difficult to predict which patients will have persistent postoperative nerve function compromise. This is a large longish-term study of the recovery of the function of the IAN from one centre in Zurich. It is a retrospective analysis of 340 patients from one university teaching hospital. It is a good paper that confirms a number of widely held thoughts. It confirms complete recovery in over 70% of patients, and discusses factors that affect recovery. Clearly fractures within the angle region have a higher degree of hypoesthesia and the authors suggest caution during ORIF. Younger patients, as expected, have better outcomes. This is a well-written paper with good methodology and worth reading if a surgeon’s practice includes treating patients with mandibular fractures.
Inferior alveolar nerve recovery after ORIF fractured mandible
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