Skip to main content
SpringerLink
Log in

Third Molar Injuries of the Trigeminal Nerve

  • Chapter
  • First Online:
Trigeminal Nerve Injuries

Abstract

Third molar extraction is one of the most common procedures performed in oral surgery. Among the possible complications, damage to the neighboring branches of the trigeminal nerve is a most dreaded complication. Although it is transient in most cases, it can leave permanent sequelae, such as hypoesthesia or dysesthesia, with a great impact on the patient’s quality of life. In the lower third molar area, the lingual nerve (LN) usually lies under the mucosa overlying the lingual cortical plate. Surgical trauma to the LN during extraction of the lower third molar is caused by inadequate handling of either the lingual cortical plate or the mucosa on the lingual aspect of the wound. Preventive measures to avoid LN injury include (1) a buccal approach without elevating or separating a lingual flap and (2) caution when removing bone or sectioning the tooth, not to perforate the lingual cortical plate. Damage to the inferior alveolar nerve (IAN) is generally related to an anatomical proximity between the third molar roots and the mandibular canal. This close relationship can be suspected using orthopantomography or intraoral radiographs but only confirmed with computed tomography (CT). Surgical techniques that reduce excessive forces or prevent nerve impingement during lower third molar extraction and postoperative care that minimizes edema are the keys to avoiding long-term IAN injury.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Hillerup S (2007) Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig 11(2):133–142

    Article  PubMed  Google Scholar 

  2. Sisk AL, Hammer WB, Shelton DW, Joy ED Jr (1986) Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 44(11):855–859

    Article  PubMed  CAS  Google Scholar 

  3. Blondeau F (1994) Paresthesia: incidence following the extraction of 455 mandibular impacted third molars. J Can Dent Assoc 60(11):991–994

    PubMed  CAS  Google Scholar 

  4. Blondeau F, Daniel NG (2007) Extraction of impacted mandibular third molars: postoperative complications and their risk factors. J Can Dent Assoc 73(4):325

    PubMed  Google Scholar 

  5. Rood JP (1992) Permanent damage to inferior alveolar and lingual nerves during the removal of impacted mandibular third molars. Comparison of two methods of bone removal. Br Dent J 172(3):108–110

    Article  PubMed  CAS  Google Scholar 

  6. Rood JP (1983) Lingual split technique. Damage to inferior alveolar and lingual nerves during removal of impacted mandibular third molars. Br Dent J 154(12):402–403

    Article  PubMed  CAS  Google Scholar 

  7. Jerjes W, Swinson B, Moles DR, El-Maaytah M, Banu B, Upile T et al (2006) Permanent sensory nerve impairment following third molar surgery: a prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102(4):e1–e7

    Article  PubMed  CAS  Google Scholar 

  8. Bataineh AB (2001) Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg 59(9):1012–1017; discussion 1017

    Article  PubMed  CAS  Google Scholar 

  9. Robert RC, Bacchetti P, Pogrel MA (2005) Fre­quency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg 63(6):732–735; discussion 736

    Article  PubMed  Google Scholar 

  10. Bruce RA, Frederickson GC, Small GS (1980) Age of patients and morbidity associated with mandibular third molar surgery. J Am Dent Assoc 101(2):240–245

    PubMed  CAS  Google Scholar 

  11. Mason DA (1988) Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg 17(5):290–294

    Article  PubMed  CAS  Google Scholar 

  12. Robinson PP, Smith KG (1996) Lingual nerve damage during lower third molar removal: a comparison of two surgical methods. Br Dent J 180(12):456–461

    Article  PubMed  CAS  Google Scholar 

  13. Wofford DT, Miller RI (1987) Prospective study of dysesthesia following odontectomy of impacted ­mandibular third molars. J Oral Maxillofac Surg 45(1):15–19

    Article  PubMed  CAS  Google Scholar 

  14. Brann CR, Brickley MR, Shepherd JP (1999) Factors influencing nerve damage during lower third molar surgery. Br Dent J 186(10):514–516

    PubMed  CAS  Google Scholar 

  15. Schultze-Mosgau S, Reich RH (1993) Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and of recovery of sensitivity. Int J Oral Maxillofac Surg 22(4):214–217

    Article  PubMed  CAS  Google Scholar 

  16. Ferrus-Torres E, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2011) Informed consent in oral surgery: the value of written information. J Oral Maxillofac Surg 69(1):54–58

    Article  PubMed  Google Scholar 

  17. Sanmarti-Garcia G, Valmaseda-Castellon E, Gay-Escoda C (2012) Does computed tomography prevent inferior alveolar nerve injuries caused by lower third molar removal? J Oral Maxillofac Surg 70(1):5–11

    Article  PubMed  Google Scholar 

  18. Colorado-Bonnin M, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2006) Quality of life following lower third molar removal. Int J Oral Maxillofac Surg 35(4):343–347

    Article  PubMed  CAS  Google Scholar 

  19. Ehrenfeld M, Cornelius CP, Altenmuller E, Riediger D, Sahl W (1992) Nerve injuries following nerve blocking in the pterygomandibular space. Dtsch Zahnarztl Z 47(1):36–39

    PubMed  CAS  Google Scholar 

  20. Pogrel MA, Renaut A, Schmidt B, Ammar A (1995) The relationship of the lingual nerve to the mandibular third molar region: an anatomic study. J Oral Maxillofac Surg 53(10):1178–1181

    Article  PubMed  CAS  Google Scholar 

  21. Miloro M, Halkias LE, Slone HW, Chakeres DW (1997) Assessment of the lingual nerve in the third molar region using magnetic resonance imaging. J Oral Maxillofac Surg 55(2):134–137

    Article  PubMed  CAS  Google Scholar 

  22. Behnia H, Kheradvar A, Shahrokhi M (2000) An anatomic study of the lingual nerve in the third molar region. J Oral Maxillofac Surg 58(6):649–651; discussion 652–653

    Article  PubMed  CAS  Google Scholar 

  23. Madeira MC, Percinoto C, das Gracas M, Silva M (1978) Clinical significance of supplementary innervation of the lower incisor teeth: a dissection study of the mylohyoid nerve. Oral Surg Oral Med Oral Pathol 46(5):608–614

    Article  PubMed  CAS  Google Scholar 

  24. Racz L, Maros T, Seres-Sturm L (1981) Anatomical variations of the nervus alveolaris inferior and their importance for the practice (author’s transl). Anat Anz 149(4):329–332

    PubMed  CAS  Google Scholar 

  25. Pichler JW, Beirne OR (2001) Lingual flap retraction and prevention of lingual nerve damage associated with third molar surgery: a systematic review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 91(4):395–401

    Article  PubMed  CAS  Google Scholar 

  26. To EW, Chan FF (1994) Lingual nerve retractor. Br J Oral Maxillofac Surg 32(2):125–126

    Article  PubMed  CAS  Google Scholar 

  27. Greenwood M, Langton SG, Rood JP (1994) A comparison of broad and narrow retractors for lingual nerve protection during lower third molar surgery. Br J Oral Maxillofac Surg 32(2):114–117

    Article  PubMed  CAS  Google Scholar 

  28. Brahams D (1992) Retractor design and the lingual nerve. Lancet 339(8796):801

    Article  PubMed  CAS  Google Scholar 

  29. Blackburn CW, Bramley PA (1989) Lingual nerve damage associated with the removal of lower third molars. Br Dent J 167(3):103–107

    Article  PubMed  CAS  Google Scholar 

  30. Carmichael FA, McGowan DA (1992) Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study. Br J Oral Maxillofac Surg 30(2):78–82

    Article  PubMed  CAS  Google Scholar 

  31. Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2000) Lingual nerve damage after third lower molar surgical extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90(5):567–573

    Article  PubMed  CAS  Google Scholar 

  32. Gargallo-Albiol J, Buenechea-Imaz R, Gay-Escoda C (2000) Lingual nerve protection during surgical removal of lower third molars. A prospective randomised study. J Oral Maxillofac Surg 29(4):268–271

    Article  CAS  Google Scholar 

  33. Queral-Godoy E, Figueiredo R, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2006) Frequency and evolution of lingual nerve lesions following lower third molar extraction. J Oral Maxillofac Surg 64(3):402–407

    Article  PubMed  Google Scholar 

  34. Gomes AC, Vasconcelos BC, de Oliveira e Silva ED, da Silva LC (2005) Lingual nerve damage after mandibular third molar surgery: a randomized clinical trial. J Oral Maxillofac Surg 63(10):1443–1446

    Article  PubMed  Google Scholar 

  35. Abu-Serriah M, Critchlow H, Whitters CJ, Ayoub A (2004) Removal of partially erupted third molars using an Erbium (Er):YAG laser: a randomised controlled clinical trial. Br J Oral Maxillofac Surg 42(3):203–208

    Article  PubMed  CAS  Google Scholar 

  36. Sivolella S, Berengo M, Bressan E, Di Fiore A, Stellini E (2011) Osteotomy for lower third molar germectomy: randomized prospective crossover clinical study comparing piezosurgery and conventional rotatory osteotomy. J Oral Maxillofac Surg 69(6):e15–e23

    Article  PubMed  Google Scholar 

  37. Renton T, McGurk M (2001) Evaluation of factors predictive of lingual nerve injury in third molar surgery. Br J Oral Maxillofac Surg 39(6):423–428

    Article  PubMed  CAS  Google Scholar 

  38. Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2001) Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92(4):377–383

    Article  PubMed  CAS  Google Scholar 

  39. Queral-Godoy E, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2005) Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99(3):259–264

    Article  PubMed  Google Scholar 

  40. Chiapasco M, Crescentini M, Romanoni G (1995) Germectomy or delayed removal of mandibular impacted third molars: the relationship between age and incidence of complications. J Oral Maxillofac Surg 53(4):418–422; discussion 422–423

    Article  PubMed  CAS  Google Scholar 

  41. Chaparro-Avendano AV, Perez-Garcia S, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2005) Morbidity of third molar extraction in patients between 12 and 18 years of age. Med Oral Patol Oral Cir Bucal 10(5):422–431

    PubMed  Google Scholar 

  42. Scottish Intercollegiate Group Network (2000) Management of unerupted and impacted third molar teeth. SIGN Publication n. 43. http://www.sign.ac.uk/guidelines/fulltext/43/index.html. Accessed 13 May 2012

  43. National Institute for Clinical Excellence (NICE) (2010) Guidance on the extraction of wisdom teeth. http://www.nice.org.uk/nicemedia/live/11385/31993/31993.pdf. Accessed 30 Mar 2012

  44. Haug RH, Perrott DH, Gonzalez ML, Talwar RM (2005) The American Association of Oral and Maxillofacial Surgeons age-related third molar study. J Oral Maxillofac Surg 63(8):1106–1114

    Article  PubMed  Google Scholar 

  45. Rood JP, Shehab BA (1990) The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 28(1):20–25

    Article  PubMed  CAS  Google Scholar 

  46. Monaco G, Montevecchi M, Bonetti GA, Gatto MR, Checchi L (2004) Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars. J Am Dent Assoc 135(3):312–318

    PubMed  Google Scholar 

  47. Leung YY, Cheung LK (2011) Correlation of radiographic signs, inferior dental nerve exposure, and deficit in third molar surgery. J Oral Maxillofac Surg 69(7):1873–1879

    Article  PubMed  Google Scholar 

  48. Sedaghatfar M, August MA, Dodson TB (2005) Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg 63(1):3–7

    Article  PubMed  Google Scholar 

  49. Park W, Choi JW, Kim JY, Kim BC, Kim HJ, Lee SH (2010) Cortical integrity of the inferior alveolar canal as a predictor of paresthesia after third-molar ­extraction. J Am Dent Assoc 141(3):271–278

    PubMed  Google Scholar 

  50. Holland CS, Hindle MO (1984) The influence of closure or dressing of third molar sockets on post-operative swelling and pain. Br J Oral Maxillofac Surg 22(1):65–71

    Article  PubMed  CAS  Google Scholar 

  51. Leist JC, Zuniga JR, Chen N, Gollehon S (1995) Experimental topical tetracycline-induced neuritis in the rat. J Oral Maxillofac Surg 53(4):427–434

    Article  PubMed  CAS  Google Scholar 

  52. Zuniga JR, Leist JC (1995) Topical tetracycline-induced neuritis: a case report. J Oral Maxillofac Surg 53(2):196–199

    Article  PubMed  CAS  Google Scholar 

  53. Frerich B, Cornelius CP, Wietholter H (1994) Critical time of exposure of the rabbit inferior alveolar nerve to Carnoy’s solution. J Oral Maxillofac Surg 52(6):599–606

    Article  PubMed  CAS  Google Scholar 

  54. Gosau M, Draenert FG, Muller S, Frerich B, Burgers R, Reichert TE et al (2010) Two modifications in the treatment of keratocystic odontogenic tumors (KCOT) and the use of Carnoy’s solution (CS) – a retrospective study lasting between 2 and 10 years. Clin Oral Investig 14(1):27–34

    Article  PubMed  Google Scholar 

  55. Pasqualini D, Cocero N, Castella A, Mela L, Bracco P (2005) Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Int J Oral Maxillofac Surg 34(1):52–57

    Article  PubMed  CAS  Google Scholar 

  56. Cerqueira PR, Vasconcelos BC, Bessa-Nogueira RV (2004) Comparative study of the effect of a tube drain in impacted lower third molar surgery. J Oral Maxillofac Surg 62(1):57–61

    Article  PubMed  Google Scholar 

  57. Ordulu M, Aktas I, Yalcin S, Azak AN, Evlioglu G, Disci R et al (2006) Comparative study of the effect of tube drainage versus methylprednisolone after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101(6):e96–e100

    Article  PubMed  Google Scholar 

  58. Kalomiri DE, Soucacos PN, Beris AE (1995) Management of ulnar nerve injuries. Acta Orthop Scand Suppl 264:41–44

    PubMed  CAS  Google Scholar 

  59. Marsh D (1990) The validation of measures of outcome following suture of divided peripheral nerves supplying the hand. J Hand Surg [Br] 15(1):25–34

    Article  CAS  Google Scholar 

  60. Tajima T, Imai H (1989) Results of median nerve repair in children. Microsurgery 10(2):145–146

    Article  PubMed  CAS  Google Scholar 

  61. Poppen NK, McCarroll HR Jr, Doyle JR, Niebauer JJ (1979) Recovery of sensibility after suture of digital nerves. J Hand Surg [Am] 4(3):212–225

    Article  CAS  Google Scholar 

  62. Barron RP, Benoliel R, Zeltser R, Eliav E, Nahlieli O, Gracely RH (2004) Effect of dexamethasone and dipyrone on lingual and inferior alveolar nerve hypersensitivity following third molar extractions: preliminary report. J Orofac Pain 18(1):62–68

    PubMed  Google Scholar 

  63. Vegas-Bustamante E, Mico-Llorens J, Gargallo-Albiol J, Satorres-Nieto M, Berini-Aytes L, ­Gay-Escoda C (2008) Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars. Int J Oral Maxillofac Surg 37(3):260–263

    Article  PubMed  CAS  Google Scholar 

  64. Mico-Llorens JM, Satorres-Nieto M, Gargallo-Albiol J, Arnabat-Dominguez J, Berini-Aytes L, Gay-Escoda C (2006) Efficacy of methylprednisolone in controlling complications after impacted lower third molar surgical extraction. Eur J Clin Pharmacol 62(9):693–698

    Article  PubMed  CAS  Google Scholar 

  65. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D et al (2007) Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg 65(11):2218–2226

    Article  PubMed  Google Scholar 

  66. Alantar A, Roisin-Chausson MH, Commissionat Y, Aaron C, Barda L, Debien J et al (1995) Retention of third molar roots to prevent damage to the inferior alveolar nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 80(2):126

    Article  PubMed  CAS  Google Scholar 

  67. Commissionat Y, Roisin-Chausson MH (1995) Lesions of the inferior alveolar nerve during extraction of the wisdom teeth. Consequences – prevention. Rev Stomatol Chir Maxillofac 96(6):385–391

    PubMed  CAS  Google Scholar 

  68. O’Riordan BC (2004) Coronectomy (intentional partial odontectomy of lower third molars). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 98(3):274–280

    PubMed  Google Scholar 

  69. Pogrel MA, Lee JS, Muff DF (2004) Coronectomy: a technique to protect the inferior alveolar nerve. J Oral Maxillofac Surg 62(12):1447–1452

    Article  PubMed  Google Scholar 

  70. Renton T, Hankins M, Sproate C, McGurk M (2005) A randomised controlled clinical trial to compare the incidence of injury to the inferior alveolar nerve as a result of coronectomy and removal of mandibular third molars. Br J Oral Maxillofac Surg 43(1):7–12

    Article  PubMed  CAS  Google Scholar 

  71. Leung YY, Cheung LK (2009) Safety of coronectomy versus excision of wisdom teeth: a randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108(6):821–827

    Article  PubMed  Google Scholar 

  72. Goto S, Kurita K, Kuroiwa Y, Hatano Y, Kohara K, Izumi M et al (2012) Clinical and dental computed tomographic evaluation 1 year after coronectomy. J Oral Maxillofac Surg 70(5):1023–1029

    Article  PubMed  Google Scholar 

  73. Cilasun U, Yildirim T, Guzeldemir E, Pektas ZO (2011) Coronectomy in patients with high risk of inferior alveolar nerve injury diagnosed by computed tomography. J Oral Maxillofac Surg 69(6):1557–1561

    Article  PubMed  Google Scholar 

  74. Leung YY, Cheung LK (2012) Coronectomy of the lower third molar is safe within the first 3 years. J Oral Maxillofac Surg 70(7):1515–1522

    Article  PubMed  Google Scholar 

  75. Landi L, Manicone PF, Piccinelli S, Raia A, Raia R (2010) A novel surgical approach to impacted mandibular third molars to reduce the risk of paresthesia: a case series. J Oral Maxillofac Surg 68(5):969–974

    Article  PubMed  Google Scholar 

  76. Landi L, Manicone PF, Piccinelli S, Raia A, Raia R (2010) Staged removal of horizontally impacted third molars to reduce risk of inferior alveolar nerve injury. J Oral Maxillofac Surg 68(2):442–446

    Article  PubMed  Google Scholar 

  77. Sencimen M, Ortakoglu K, Aydin C, Aydintug YS, Ozyigit A, Ozen T et al (2010) Is endodontic treatment necessary during coronectomy procedure? J Oral Maxillofac Surg 68(10):2385–2390

    Article  PubMed  Google Scholar 

  78. Tolstunov L (2010) Pericoronal ostectomy as alternative treatment option for extraction of impacted mandibular third molars in proximity to inferior alveolar nerve. J Oral Maxillofac Surg 68(1):231–232

    Article  PubMed  Google Scholar 

  79. Tolstunov L, Javid B, Keyes L, Nattestad A (2011) Pericoronal ostectomy: an alternative surgical technique for management of mandibular third molars in close proximity to the inferior alveolar nerve. J Oral Maxillofac Surg 69(7):1858–1866

    Article  PubMed  Google Scholar 

  80. Hirsch A, Shteiman S, Boyan BD, Schwartz Z (2003) Use of orthodontic treatment as an aid to third molar extraction: a method for prevention of mandibular nerve injury and improved periodontal status. J Periodontol 74(6):887–892

    Article  PubMed  CAS  Google Scholar 

  81. Checchi L, Alessandri Bonetti G, Pelliccioni GA (1996) Removing high-risk impacted mandibular third molars: a surgical-orthodontic approach. J Am Dent Assoc 127(8):1214–1217

    PubMed  CAS  Google Scholar 

  82. Bonetti GA, Parenti SI, Checchi L (2008) Orthodontic extraction of mandibular third molar to avoid nerve injury and promote periodontal healing. J Clin Periodontol 35(8):719–723

    Article  PubMed  Google Scholar 

  83. Ridaura-Ruiz L, Figueiredo R, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C (2012) Sensibility and taste alterations after impacted lower third molar extractions. A prospective cohort study. Med Oral Patol Oral Cir Bucal 17(5):e759–e764

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Dentistry, IDIBELL Institute, University of Barcelona, Barcelona, Spain

    Eduard Valmaseda-Castellón DDS, PhD & Cosme Gay-Escoda DDS, MD, PhD

  2. Department of Oral and Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain

    Cosme Gay-Escoda DDS, MD, PhD

Authors
  1. Eduard Valmaseda-Castellón DDS, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cosme Gay-Escoda DDS, MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eduard Valmaseda-Castellón DDS, PhD .

Editor information

Editors and Affiliations

  1. , Oral and Maxillofacial Surgery, University of Illinois, S. Paulina St. MC 835 801, Chicago, 60612, Illinois, USA

    Michael Miloro

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Valmaseda-Castellón, E., Gay-Escoda, C. (2013). Third Molar Injuries of the Trigeminal Nerve. In: Miloro, M. (eds) Trigeminal Nerve Injuries. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35539-4_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-35539-4_5

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-35538-7

  • Online ISBN: 978-3-642-35539-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation