Cochrane · intervention · CD005293
Interventions for iatrogenic inferior alveolar and lingual nerve injury
Coulthard, P, Kushnerev, E, Yates, JM, et al. · Cochrane Database of Systematic Reviews · 2014 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
16
current version
GRADE rated
2
No studies
12
Included studies
2
as reported
No studies 12 · 75%Ungraded 2 · 12.5%Very low 2 · 12.5%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients of any age in any setting requiring intervention for iatrogenic injury to the inferior alveolar or lingual nerve | 31 participants randomised across two trials, 26 analysed; adults aged 17 to 55 years with partial altered sensation due to inferior alveolar nerve injury after oral surgery (n=26) |
| Intervention | Surgical (exploration and external neurolysis, internal neurolysis, neurorrhaphy, neuroma excision, tubulization, grafting, laser); Medical (systemic: analgesics, antidepressants, antiepileptics, steroids; topical: analgesics, anaesthetics); Psychological (counselling, acupuncture, cognitive behavioural therapy, relaxation therapy, behaviour modification, electromyographic biofeedback, hypnosis, re-education) | Low-level laser therapy (photon-plus GaAlAs diode laser; 70 mW, 820 nm) (n=26) |
| Comparison | A different active intervention (direct comparison), or no treatment; also the same intervention delivered at different time points | Placebo (sham) laser therapy (n=26) |
| Outcomes | Primary: pain; patient-reported altered sensation (spontaneous or evoked: anaesthesia/paraesthesia/dysaesthesia/hyperalgesia/allodynia); difficulty eating; difficulty speaking; taste. Secondary: quality of life/patient satisfaction; adverse events; mechanosensory (pin prick/two-point/light touch/pressure/pain/thermal thresholds); thermosensory; somatosensory evoked potentials | Patient-reported altered sensation, VAS change at chin and lip (n=13); mechanosensory perception (n=26); thermosensory perception (n=25) |
| Study designs | All randomised controlled trials (RCTs) comparing interventions for the treatment of iatrogenic inferior alveolar or lingual nerve injury | Two two-arm parallel-group RCTs (Khullar 1996a, Norway; Khullar 1996b, Sweden), both at high risk of bias (n=2) |
| Timing | Outcomes categorised by timing closest to < 3 months, ≤ 6 months, > 6 months post-operative | Not reported |
Search date: 2013-10. Databases: Cochrane Oral Health Group's Trial Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform
Questions and results
Show all 2 versionsLow-level laser therapy (photon-plus GaAlAs diode laser; 70 mW output, continuous 820 nm) vs Placebo (sham) laser therapy
Population: Patients of any age in any setting requiring intervention for iatrogenic injury to the inferior alveolar or lingual nerve
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient-reported altered sensation (spontaneous or evoked: anaesthesia/paraesthesia/dysaesthesia/hyperalgesia/allodynia) Lip | MD 21.79 [5.29, 38.29] | 1 study · 13 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Somatosensory evoked potentials | Results: 'No studies reported on ... somatosensory evoked potentials ...'. Not reported by the included trials. | 0 studies | No studies |
Patient-reported altered sensation (spontaneous or evoked: anaesthesia/paraesthesia/dysaesthesia/hyperalgesia/allodynia) Chin | MD 8.40 [3.67, 13.13] -0.68 cm (mean change in sensation, placebo group; VAS 0 to 10 cm) vs 8.40 cm greater than placebo (mean change in the… | 1 study · 13 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Mechanosensory perception (load in grams to elicit sensation; Semmes Weinstein monofilaments) | MD 1.07 [0.17, 1.97] | 2 studies · 26 participants | Ungraded |
Difficulty speaking | SoF row 'Difficulty speaking': This outcome was not reported in the included studies. | 0 studies | No studies |
Difficulty eating | SoF row 'Difficulty eating': This outcome was not reported in the included studies. | 0 studies | No studies |
Quality of life | Results: 'No studies reported on quality of life ...'. Not reported by the included laser trials. | 0 studies | No studies |
Adverse events | SoF row 'Adverse events': This outcome was not reported in the included studies. | 0 studies | No studies |
Pain | SoF row 'Pain': This outcome was not reported in the included studies. | 0 studies | No studies |
Taste | SoF row 'Taste': This outcome was not reported in the included studies. | 0 studies | No studies |
Thermosensory (thermal) perception | MD 1.79 [-2.04, 5.62] | 2 studies · 25 participants | Ungraded |
Patient satisfaction | Results: no included study reported quality of life or patient satisfaction. In PUB2 patient satisfaction is merged with quality of life as 'quality of life/patient satisfaction'. | 0 studies | No studies |
Medical interventions (systemic: analgesics, antidepressants, antiepileptics, steroids; topical: analgesics, anaesthetics) vs Another intervention, or no intervention
Population: Patients of any age in any setting requiring intervention for iatrogenic injury to the inferior alveolar or lingual nerve
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Results: 'No studies evaluated medical ... interventions.' No eligible RCT of medical interventions (analgesics, antidepressants, antiepileptics, steroids, topical anaesthetics). | 0 studies | No studies |
Psychological / counselling interventions (counselling, acupuncture, cognitive behavioural therapy, relaxation therapy, behaviour modification, electromyographic biofeedback, hypnosis, re-education) vs Another intervention, or no intervention
Population: Patients of any age in any setting requiring intervention for iatrogenic injury to the inferior alveolar or lingual nerve
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Results: 'No studies evaluated ... psychological interventions.' No eligible RCT of psychological / counselling interventions (CBT, relaxation, behaviour modification, biofeedback, hypnosis, re-education, acupuncture). | 0 studies | No studies |
One active intervention (surgical, medical, or psychological) vs A different active intervention (direct head-to-head comparison)
Population: Patients of any age in any setting requiring intervention for iatrogenic injury to the inferior alveolar or lingual nerve
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | Discussion: 'There is also a lack of trials directly comparing these methods ...'. No eligible RCT directly comparing different active interventions. | 0 studies | No studies |
An intervention delivered at one time point vs The same intervention delivered at a different time point
Population: Patients of any age in any setting requiring intervention for iatrogenic injury to the inferior alveolar or lingual nerve
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR < 3 months; ≤ 6 months; > 6 months | Discussion / Methods: no trials addressed optimal timing; the planned timing subgroup analyses (< 3 months, ≤ 6 months, > 6 months) could not be undertaken. | 0 studies | No studies |