Posted at the Institutional Resources for Unique Collection and Academic Archives at Tokyo Dental College, Available from http://ir.tdc.ac.jp/
Title
Alternative technique to repair damaged inferior alveolar nerve using data fusion from computed tomographic and magnetic resonance imaging
Author(s) Alternative
Nishiyama, A; Odaka, K; Koyachi, M; Sugahara, K;
Katakura, A
Journal The British journal of oral & maxillofacial surgery, 60(2): 207‑208
URL http://hdl.handle.net/10130/6022
Right
©2020 The Author(s). Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons. This is an open access article under the CC BY‑NC‑ND license
(http://creativecommons.org/licenses/by‑nc‑
nd/4.0/).
Description
BritishJournalofOralandMaxillofacialSurgery60(2022)207–208 Availableonlineatwww.sciencedirect.com
ScienceDirect
Technical note
Alternative technique to repair damaged inferior alveolar nerve using data fusion from computed tomographic and magnetic resonance imaging
A. Nishiyama
a,∗, K. Odaka
b, M. Koyachi
a, K. Sugahara
a, A. Katakura
aaDepartmentofOralPathobiologicalScienceandSurgery,TokyoDentalCollege,Tokyo,Japan
bDepartmentofOralandMaxillofacialRadiology,TokyoDentalCollege,Tokyo,Japan
Accepted4September2020 Availableonline11September2020
Keywords:Inferioralveolarnerve;fusion;nerverepair
Iatrogenic inferior alveolar nerve damage may occur as a result of third molar extractions, placement of dental implants, orthognathicsurgery, removal of a cyst,andthe excisionofmaxillarytumours.1Severedamagetotheinferior alveolarnerverequiresrepair,andtherearethreestepstothe method.Thefirststepistheremovalofthebuccalsidecortical boneofthedamagednerveaftertheraisingoftheflap,fol- lowedbyremovalofthecancellousbonetoaidtheapproach totheinferioralveolarnerve.Thethirdstepisnerverepairby neurolysis,directepineurialrepair,oranindirectneurorrha- phy.Thismethodischallengingduetothenarrowintraoral operativeroute.Thesurgicalprocedurebecomeshighlycom- plexinanattempttocoverthepositionofthedamagednerve.
Itisfurthercomplicatedbythepositionofthecorticalbonein relationtothedamagednerve.Wereporttheclinicalapproach andthesafetymarginof the operation,whichtargetedthe softtissue lesioninthe jaw(invasive squamouscellcarci- noma)using3-dimensionalcomputedtomography(CT)and magneticresonanceimaging(MRI).2 Wepresentacasein whichwewereabletouseaminimallyinvasive andaccu- rateapproachtorepairinferioralveolarnervedamageusing asurgicalguidederivedfromdatafusionderivedfromCT andMRIimages.
∗Correspondingauthorat:2-9-18Kanda-Misakicho,Chiyoda-ku,Tokyo 101-0061,Japan.Fax:+81-3-3262-3213.
E-mailaddress:[email protected](A.Nishiyama).
Fig.1.The3Dimageshowingmandible withtraumaticneuromafused betweenCTandMRI,andplannedformofsurgicalguide.
A61-year-oldwomanhadhadherinferioralveolarnerve damaged after aleft-sided mandibularthird molar extrac- tioninadentalclinic.Adiagnosisofneurotmesiswasmade, usingSeddon’sclassification,3withtheformationofatrau- maticneuromaandwedecidedtoattemptnerverepairafter inspecting imagingandnotingthe patient’ssymptoms.We examinedfusiondatafromCTandMRI(showingthenerve andmandible)beforeanoperationusingplanningsoftware (MaterialiseMimics)(Fig.1).Thefusiondatawasobtained fromthemandibularcanalbyCT,andtheinferioralveolar nervebyMRI,andthreepointswererecordedas common
https://doi.org/10.1016/j.bjoms.2020.09.010
0266-4356/©2020TheAuthor(s).PublishedbyElsevierLtdonbehalfofTheBritishAssociationofOralandMaxillofacialSurgeons.Thisisanopenaccess articleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).
208 A.Nishiyamaetal./BritishJournalofOralandMaxillofacialSurgery60(2022)207–208
Fig.2.Surgicalguideproducedbythe3Dfusiondata.
Fig.3.Thesurgicalguidesetontheleftmandiblewiththesecondmolaras ananchor.
points in both sets of radiological data. A surgical guide wasproduced,using this3-dimensionalfusionimaging,to serveasananchorand1–3facilitatetheremovalofthecorti- calboneonthebuccalside(Figs.2–4).Theguideincluded the thicknessup tothe mandibularcanal onthis side.We excisedtheneuromaoncetheinferioralveolarnervewasvis- ibleandtransplantedthegreatauricularnerve.Theexcision lesionwasabout23mm,whichwasplannedafterradiological diagnosis.
Fusion images of CT andMRI helped to visualise the damagednerveinthejaw.ComparedwithCTalone,theaddi- tionofMRIdatamakesitpossibletoidentifythecondition
Fig.4.Thetraumaticneuromawasrevealedafterremovalofthebuccal corticalbone.
andextentoftheinjurytothenerveandisanimportantaid in deciding adiagnosis and operation plan. In addition, it makesit possibletouseminimalintervention,andensures thesafetyandsuccessoftheoperationbyhelpingtoproduce thesurgicalguidefromthefusionofthetwoimagingtypes.
Conflictofinterest
Wehavenoconflictsofinterest.
Ethicsstatement/confirmationofpatient’spermission
Ethics approval was not required. Consent was given by patientforuseoftheirphotographsinthispublication.
References
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3.SeddonHJ.Aclassificationofnerveinjuries.BMJ1942;2:237.
