Lingual flap retraction and prevention of lingual nerve damage associated with third molar surgery: A systematic review of the literature

Objective, Lingual nerve damage sometimes occurs after the removal of third molars. The use oi a lingual retractor has been advocated to protect the l ingual nerve. A systematic review of the literature was undertaken to evalu ate the incidence of lingual nerve damage after third molar surgery and the effect oi a lingual retractor on nerve damage. Study design. An exhaustive computerized search oi several databases and re ferences cited in the various studies was performed. Predetermined inclusio n and exclusion criteria were used to identify the 8 published studies acce ptable for detailed analysis. The incidence and spontaneous recovery oi lin gual nerve injury for the following 3 surgical techniques were evaluated: t he buccal approach with lingual flap retraction (BA+), or the buccal approa ch without lingual flap retraction (BA-), and the lingual split technique w ith lingual flap retraction (LS). Results. In the 8 selected articles, lingual nerve injury occurred in 9.6%, 6.4%, and 0.6% of the pooled LS, BA+, and BA-procedures, respectively. On the basis of risk ratios comparing combined incidence rates, lingual nerve injury is 8.8 times more likely to occur in BA+ than in BA- procedures (CI = 4.3-17.8), 13.3 times more likely to occur in LS than in BA- procedures ( Cl = 6.6-26.9), and 1.5 times more likely to occur in LS than in BA+ proced ures (CI = 1.2-1.8). Permanent lingual nerve injury occurred in 0.1%, 0.6%, and 0.2% of the combined LS, BA+, and BA- procedures, respectively. The co mbined permanent incidence risk ratios were not calculated because of the l ow permanent incidence rates. Conclusions, The use of a lingual nerve retractor during third molar surger y was associated with an increased incidence of temporary nerve damage and was neither protective nor detrimental with respect to the incidence oi per manent nerve damage.