Acta Medica Leopoliensia (Sep 2019)
Clinical and electrophysiological evaluation of the lower alvelolar nerve status in patients after removal of radicular cysts by various methods
Abstract
Aim. To give a clinical and electrophysiological assessment of the condition of the lower alveolar nerve in patients after the removal of radicular cysts by various methods. Material and Methods. The research involved 40 patients (18 men and 22 women) with radicular cysts located in the lateral region of the mandible. Patients, depending on the method of cystectomy, were divided into two clinical groups. The 1st group included 21 patients, in which the cystectomy was performed according to a standard method, in which the enucleation of the cysts membranes was carried out by hand tools (raspatory, curette ); The 2nd group included - 19 patients, in which the extraction of the membranes of cysts was carried out by using piezoelectric surgical technique. The NTSS-9 scale was used for screening of the symptoms of lower alveolar nerve neuropathy (LAN), and the tactile and pain sensitivity status was assessed by a four-point scale. Degree of the LAN damage was detected by their electrophysiological testing. The Pearson correlation coefficient (c2) was used to determine the correlation between the indices in the comparative groups. Results and Discussion. In 3 patients from the first clinical group and in 4 patients from the second group, in which radicular cysts of small sizes were removed, functional lesions of the lower alveolar nerve were not detected during the study of tactile and pain sensitivity of the lower lip. In 18 patients from the first and 15 patients from the second clinical group, a mild degree of neuropathy of the LAN was diagnosed. In 2 patients from the first clinical group after the removal of large size radicular cysts by a standard method, a neuropathy of the lower alveolar nerve, of moderate severity, arose. In all patients, in which large sized radicular cysts of the mandibles were removed by the standard method, on the 1st day of the postoperative period, clinical and electrophysiological manifestations of the examined nerve neuropathy were detected: in 8 cases - the mild degree, in 2 cases - moderate degree. After application in the patients of piezoelectric technique of enucleation of radicular cysts of the mandible of large sizes in a similar period of observation, only manifestations of mild degeneration of the function of the lower alveolar nerve were present - c2=11,12, p<0,001. On the 7th day of the postoperative period, the function of the lower alveolar nerve in 5 patients from the first group and in 13 patients from the second group normalized on the background of pharmacological and physiotherapeutic treatment - c2=7,63, p<0,01. However, in 7 patients from the first clinical group and in 2 patients from the second group, in which odontogenic cysts of large size were removed, the clinical symptoms of neuropathy of the mild degree of the examined nerve have not yet completely disappeared. In 2 patients from the first study group, clinical and electrofunctional manifestations of the lower alveolar nerve neuropathy of moderate degree were present - c2=8,92 , p<0,01. Conclusions. After removal of middle and large radicular cysts located in the lateral areas of the mandible by a standard method, traumatic neuropathy of the lower alveolar nerve of different degrees of severity is developed in most patients. The application of piezoelectric surgical technique during removal of radicular cysts of the mandible of small and medium sizes prevents the development of traumatic neuropathy of the lower alveolar nerve. During the ultrasound enucleation of large size radicular cysts located in lateral areas of mandible, in the statistical expression c2=8,92 (p<0,01), the incidence of traumatic damage of this nerve is reduced, which is confirmed by clinical and electrophysiological research methods.
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