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05-03-2025 | Computed Tomography | Original Article

Association between CT image findings and hypoesthesia in the mental region and lower lip after dentigerous cyst removal: a retrospective study and literature review

Authors: Shinichiro Yamada, Hizuru Osanai, Kozue Mori, Noriyuki Sugino, Akira Taguchi

Abstract

Objectives

To evaluate the role of computed tomography (CT)/cone-beam computed beam CT (CBCT) in association with hypoesthesia of the mental region and lower lip during the surgical removal of DCs.

Methods

A retrospective cohort study was performed involving 39 impacted mandibular DC cases between February 2011 and March 2022. We studied the association of hypoesthesia in relation to the age and sex of the patient and to growth direction and expansion of the DC on the CT/CBCT image findings. The preoperative CT/CBCT image findings were statistically analyzed in accordance with diagnoses of DCs confirmed based on pathology. Fisher’s exact test was used to test the relationship between hypoesthesia and CT/CBCT imaging findings. In addition, PubMed and PubMed Central were searched using keywords such as “hypoesthesia” to find relevant studies. Reports of hypoesthesia of the mental region and lower lip were derived from the selected literature.

Results

The frequency of hypoesthesia recorded was 35.9%. No statistically significant association was observed for all hypoesthesia and CT/CBCT image findings.

Conclusions

Imaging evaluation was performed in 39 dentigerous cysts, and a literature review was performed. We found that CT/CBCT alone does not provide sufficiently reliable images required for predicting nerve lesions. Future prospective studies are required.

Charles AW. Odontogenic cyst and tumors. In: Neville B, Damm DD, Allen C, Bouquot J, editors. Oral and maxillofacial pathology. 3rd ed. Elsevier; 2008. p. 678–740.

Rajendra Santosh AB. Odontogenic cysts. Dent Clin North Am. 2020;64(1):105–19. https://doi.org/10.1016/j.cden.2019.08.002.CrossRefPubMed

Zhang LL, Yang R, Zhang L, Li W, MacDonald-Jankowski D, Poh CF. Dentigerous cyst: a retrospective clinicopathological analysis of 2082 dentigerous cysts in British Columbia. Canada Int J Oral Maxillofac Surg. 2010;39(9):878–82. https://doi.org/10.1016/j.ijom.2010.04.048.CrossRefPubMed

Koenig LJ. Mandible and maxilla. In: Koenig LJ, Tamini D, Petrikowski CG, Harnsberger HR, Ruprecht A, Benson BW, Van Dis ML, Hatcher D, Perschbacher SE, editors. Diagnosis Imaging Oral and Maxillofacial. Amirsys, Milwaukee, WI: 2012; pp. 50–53, 100–1032.

Lin HP, Wang YP, Chen HM, Cheng SJ, Sun A, Chiang CP. A clinicopathological study of 338 dentigerous cysts. J Oral Pathol Med. 2013;42(6):462–7. https://doi.org/10.1111/jop.12042.CrossRefPubMed

Tay AB, Zuniga JR. Clinical characteristics of trigeminal nerve injury referrals to a university centre. Int J Oral Maxillofac Surg. 2007;36(10):922–7. https://doi.org/10.1016/j.ijom.2007.03.012.CrossRefPubMed

Varvara G, Feragalli B, Turkyilmaz I, D’Alonzo A, Rinaldi F, Bianchi S, et al. Prevalence and characteristics of accessory mandibular canals: A cone-beam computed tomography study in a European adult population. Diagnostics (Basel). 2022;12(8):1885. https://doi.org/10.3390/diagnostics12081885.CrossRefPubMed

Tantanapornkul W, Okouchi K, Fujiwara Y, Yamashiro M, Maruoka Y, Ohbayashi N, et al. A comparative study of cone-beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(2):253–9. https://doi.org/10.1016/j.tripleo.2006.06.060.CrossRefPubMed

Brahm CO, Lundgren J, Carlsson SG, Nilsson P, Corbeil J, Hagglin C. Dentists’ views on fearful patients. Problems and promises. Swed Dent J. 2012;36(2):79–89.PubMed

10.

Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48(3):452–8.CrossRefPubMed

11.

Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74(4):491–516.CrossRefPubMed

12.

Dorland’s illustrated medical dictionary. Dorland. In: 25th ed. Japanese ed. Philadelphia-London-Toronto: W. B. Saunders Company. Philadelphia: Hirokawa Publishing Co., 1980; 1965.

13.

Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study. Br J Oral Maxillofac Surg. 1992;30(2):78–82. https://doi.org/10.1016/0266-4356(92)90074-s.CrossRefPubMed

14.

Jerjes W, Upile T, Shah P, Nhembe F, Gudka D, Kafas P, et al. Risk factors associated with injury to the inferior alveolar and lingual nerves following third molar surgery-revisited. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(3):335–45. https://doi.org/10.1016/j.tripleo.2009.10.010.CrossRefPubMed

15.

Osborn TP, Frederickson G, Small IA, Torgerson TS. A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg. 1985;43(10):767–9. https://doi.org/10.1016/0278-2391(85)90331-3.CrossRefPubMed

16.

Wofford DT, Miller RI. Prospective study of dysesthesia following odontectomy of impacted mandibular third molars. J Oral Maxillofac Surg. 1987;45(1):15–9. https://doi.org/10.1016/0278-2391(87)90080-2.CrossRefPubMed

17.

Mason DA. Lingual nerve damage following lower third molar surgery. Int J Oral Maxillofac Surg. 1988;17(5):290–4. https://doi.org/10.1016/s0901-5027(88)80005-5.CrossRefPubMed

18.

Von Arx DP, Simpson MT. The effect of dexamethasone on neurapraxia following third molar surgery. Br J Oral Maxillofac Surg. 1989;27(6):477–80. https://doi.org/10.1016/s0266-4356(89)80005-1.CrossRef

19.

Blackburn CW, Bramley PA. Lingual nerve damage associated with the removal of lower third molars. Br Dent J. 1989;167(3):103–7. https://doi.org/10.1038/sj.bdj.4806922.CrossRefPubMed

20.

Rood JP. Permanent damage to inferior alveolar and lingual nerves during the removal of impacted mandibular third molars. Rood JP. Comparison of two methods of bone removal. Br Dent J. 1992;172(3):108–10. https://doi.org/10.1038/sj.bdj.4807777.CrossRefPubMed

21.

Schultze-Mosgau S, Reich RH. Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and of recovery of sensitivity. Int J Oral Maxillofac Surg. 1993;22(4):214–7. https://doi.org/10.1016/s0901-5027(05)80638-1.CrossRefPubMed

22.

Absi EG, Shepherd JP. A comparison of morbidity following the removal of lower third molars by the lingual split and surgical bur methods. Int J Oral Maxillofac Surg. 1993;22(3):149–53. https://doi.org/10.1016/s0901-5027(05)80240-1.CrossRefPubMed

23.

Chiapasco M, Pedrinazzi M, Motta J, Crescentini M, Ramundo G. Surgery of lower third molars and lesions of the lingual nerve. Minerva Stomatol. 1996;45(11):517–22.PubMed

24.

Brann CR, Brickley MR, Shepherd JP. Factors influencing nerve damage during lower third molar surgery. Br Dent J. 1999;186(10):514–6. https://doi.org/10.1038/sj.bdj.4800155.CrossRefPubMed

25.

Marbach JJ, Raphael KG. Phantom tooth pain: a new look at an old dilemma. Pain Med. 2000;1(1):68–77. https://doi.org/10.1046/j.1526-4637.2000.00012.x.CrossRefPubMed

26.

Vickers ER, Cousins MJ. Neuropathic orofacial pain part 1–prevalence and pathophysiology. Aust Endod J. 2000;26(1):19–26. https://doi.org/10.1111/j.1747-4477.2000.tb00146.x.CrossRefPubMed

27.

Gülicher D, Gerlach KL. Sensory impairment of the lingual and inferior alveolar nerves following removal of impacted mandibular third molars. Intl J Oral Maxillofac Surg. 2001;30(4):306–12. https://doi.org/10.1054/ijom.2001.0057.CrossRef

28.

Bataineh AB. Sensory nerve impairment following mandibular third molar surgery. J Oral Maxillofac Surg. 2001;59(9):1012–7. https://doi.org/10.1053/joms.2001.25827.CrossRefPubMed

29.

Renton T, McGurk M. Evaluation of factors predictive of lingual nerve injury in third molar surgery. Br J Oral Maxillofac Surg. 2001;39(6):423–8. https://doi.org/10.1054/bjom.2001.0682.CrossRefPubMed

30.

Berge TI. Incidence of chronic neuropathic pain subsequent to surgical removal of impacted third molars. Acta Odontol Scand. 2002;60(2):108–12. https://doi.org/10.1080/000163502753509518.CrossRefPubMed

31.

Queral Godoy E, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(3):259–64.CrossRefPubMed

32.

Renton T, Yilmaz Z. Managing iatrogenic trigeminal nerve injury: a case series and review of the literature. Int J Oral Maxillofac Surg. 2012;41(5):629–37. https://doi.org/10.1016/j.ijom.2011.11.002.CrossRefPubMed

33.

Nguyen E, Grubor D, Chandu A. Risk factors for permanent injury of inferior alveolar and lingual nerves during third molar surgery. J Oral Maxillofac Surg. 2014;72(12):2394–401. https://doi.org/10.1016/j.joms.2014.06.451.CrossRefPubMed

34.

Pogrel MA, Thamby S. Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Am Dent Assoc. 2000;131(7):901–7. https://doi.org/10.14219/jada.archive.2000.0308.CrossRefPubMed

35.

Loescher AR, Smith KG, Robinson PP. Nerve damage and third molar removal. Dent Update. 2003;30(7):375–80. https://doi.org/10.12968/denu.2003.30.7.375.CrossRefPubMed

36.

Renton T. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dent update. 2010;37(6):350–2.CrossRefPubMed

37.

Jones RH. Microsurgical repair of nerves injured during third molar surgery. Aust Dent J. 1992;37(4):253–61. https://doi.org/10.1111/j.1834-7819.1992.tb04740.x.CrossRefPubMed

38.

Rood JP, Shehab BA. The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg. 1990;28(1):20–5. https://doi.org/10.1016/0266-4356(90)90005-6.CrossRefPubMed

39.

Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. 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. 2001;92(4):377–83. https://doi.org/10.1067/moe.2001.118284.CrossRefPubMed

40.

Sedaghatfar M, August MA, Dodson TB. Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg. 2005;63(1):3–7. https://doi.org/10.1016/j.joms.2004.05.217.CrossRefPubMed

41.

Gomes AC, do Egito Vasconcelos BC, de Oliveira Silva ED, de França CA, Neto ICP. Sensitivity and specificity of pantomography to prodict inferior alveolar nerve damage during extraction of impacted lower third molars. J Oral Mawillofac Surg. 2008;66(2):256–9.CrossRef

42.

Kipp DP, Goldstein BH, Weiss WW Jr. Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures. J Am Dent Assoc. 1980;100(2):185–92.CrossRefPubMed

43.

Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Lingual nerve damage after third lower molar surgical extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;90(5):567–73. https://doi.org/10.1067/moe.2000.110034.CrossRefPubMed

44.

Hillerup S, Stoltze K. Lingual nerve injury in third molar surgery I. Observations on recovery of sensation with spontaneous healing. Int J Oral Maxillofac Surg. 2007;36(10):884–9. https://doi.org/10.1016/j.ijom.2007.06.004.CrossRefPubMed

45.

Alling CC. Dysesthesia of the lingual and inferior alveolar nerves following third molar surgery. J Oral Maxillofac Surg. 1986;44(6):454–7. https://doi.org/10.1016/s0278-2391(86)80010-6.CrossRefPubMed

46.

Van Sickels JE, Hatch JP, Dolce C, Bays RA, Rugh JD. Effects of age, amount of advancement and genioplasty on neurosensory disturbance after a bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 2002;60(9):1012–7. https://doi.org/10.1053/joms.2002.34411.CrossRefPubMed

47.

Rood JP. Degrees of injury to the inferior alveolar nerve sustained during the removal of impacted mandibular third molars by the lingual split technique. Br J Oral Surg. 1983;21(2):103–16. https://doi.org/10.1016/0007-117x(83)90054-9.CrossRefPubMed

48.

Rood JP. Lingual split technique: damage to inferior alveolar and lingual nerves during removal of impacted mandibular third molars. Br Dent J. 1983;154(12):402–3. https://doi.org/10.1038/sj.bdj.4805103.CrossRefPubMed

49.

Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH. Incidence of neurosensory deficits and recovery after lower third molar surgery: A prospective clinical study of 4338 cases. Int J Oral Maxillofac Surg. 2010;39(4):320–6. https://doi.org/10.1016/j.ijom.2009.11.010.CrossRefPubMed

50.

Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig. 2007;11(2):133–42. https://doi.org/10.1007/s00784-006-0089-5.CrossRefPubMed

51.

Kjølle GK, Bjørnland T. Low risk of neurosensory dysfunction after mandibular third molar surgery in patients less than 30 years of age. A prospective study following removal of 1220 mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(4):411–7. https://doi.org/10.1016/j.oooo.2013.06.024.CrossRefPubMed

52.

Robert RC, Bacchetti P, Pogrel MA. Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg. 2005;63(6):732–5. https://doi.org/10.1016/j.joms.2005.02.006.CrossRefPubMed

53.

Gülicher D, Inzidenz GKL. Risikofaktoren und Verlauf von Sensibilitätsstörungen nach operativer Weisheitszahnentfernung. Untersuchung an 1106 Fällen. Incidence, risk factors and follow-up of sensation disorders after surgical wisdom tooth removal. Study of 1,106 cases. Mund Kiefer Gesichtschir. 2000;4(2):99–104. https://doi.org/10.1007/s100060050178.CrossRefPubMed

54.

Kim JW, Cha IH, Kim SJ, Kim MR. Which risk factors are associated with neurosensory deficits of inferior alveolar nerve after mandibular third molar extraction? J Oral Maxillofac Surg. 2012;70(11):2508–14. https://doi.org/10.1016/j.joms.2012.06.004.CrossRefPubMed

55.

Pogrel MA, Jergensen R, Burgon E, Hulme D. Long-term outcome of trigeminal nerve injuries related to dental treatment. J Oral Maxillofac Surg. 2011;69(9):2284–8. https://doi.org/10.1016/j.joms.2011.02.023.CrossRefPubMed

56.

Leung YY, Fung PPL, Cheung LK. Treatment modalities of neurosensory deficit after lower third molar surgery: a systematic review. J Oral Maxillofac Surg. 2012;70(4):768–78. https://doi.org/10.1016/j.joms.2011.08.032.CrossRefPubMed

Title: Association between CT image findings and hypoesthesia in the mental region and lower lip after dentigerous cyst removal: a retrospective study and literature review
Authors: Shinichiro Yamada
Hizuru Osanai
Kozue Mori
Noriyuki Sugino
Akira Taguchi
Publication date: 05-03-2025
Publisher: Springer Nature Singapore
Keywords: Computed Tomography
Computed Tomography
Digital Volume Tomography
Digital Volume Tomography
Published in: Oral Radiology
Print ISSN: 0911-6028
Electronic ISSN: 1613-9674
DOI: https://doi.org/10.1007/s11282-025-00813-6

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Springer Medicine

Association between CT image findings and hypoesthesia in the mental region and lower lip after dentigerous cyst removal: a retrospective study and literature review

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on advances in lupus

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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