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

Oral Health Oral and maxillofacial surgery2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

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

Current version only

Low-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

CD005293.PUB2 (current) · 12 questions

Outcome	Effect	Evidence	Status / GRADE
Patient-reported altered sensation (spontaneous or evoked: anaesthesia/paraesthesia/dysaesthesia/hyperalgesia/allodynia) Lip same question in other reviews	MD 21.79 [5.29, 38.29]	1 study · 13 participants	Very low Downgraded: risk of bias, imprecision, indirectness
Somatosensory evoked potentials same question in other reviews	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 same question in other reviews	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) same question in other reviews	MD 1.07 [0.17, 1.97]	2 studies · 26 participants	Ungraded
Difficulty speaking same question in other reviews	SoF row 'Difficulty speaking': This outcome was not reported in the included studies.	0 studies	No studies
Difficulty eating same question in other reviews	SoF row 'Difficulty eating': This outcome was not reported in the included studies.	0 studies	No studies
Quality of life same question in other reviews	Results: 'No studies reported on quality of life ...'. Not reported by the included laser trials.	0 studies	No studies
Adverse events same question in other reviews	SoF row 'Adverse events': This outcome was not reported in the included studies.	0 studies	No studies
Pain same question in other reviews	SoF row 'Pain': This outcome was not reported in the included studies.	0 studies	No studies
Taste same question in other reviews	SoF row 'Taste': This outcome was not reported in the included studies.	0 studies	No studies
Thermosensory (thermal) perception same question in other reviews	MD 1.79 [-2.04, 5.62]	2 studies · 25 participants	Ungraded
Patient satisfaction same question in other reviews	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

CD005293.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	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

CD005293.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	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

CD005293.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR same question in other reviews	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

CD005293.PUB2 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR < 3 months; ≤ 6 months; > 6 months same question in other reviews	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