COMPARISON OF PERIOSTEAL ELEVATOR WITH AND WITHOUT DEXAMETHASONE INJECTION FOR THE PREVENTION OF LINGUAL NERVE INJURY IN AN OPEN EXTRACTION OF MANDIBULAR THIRD MOLARS

A GUL; JA KUNDI; A AHMAD

doi:10.54112/pjicm.v5i02.185

Authors

A GUL Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College, Peshawar, Pakistan
JA KUNDI Department of Oral and Maxillofacial Surgery, Sardar Begum Dental College, Peshawar, Pakistan
A AHMAD University Hospital Waterford, County Waterford, Ireland

DOI:

https://doi.org/10.54112/pjicm.v5i02.185

Keywords:

Lingual Nerve Injury, Dexamethasone, Periosteal Elevator, Third Molar Extraction, Neurosensory Testing, Randomized Controlled Trial.

Abstract

Background: Lingual nerve injury (LNI) is a recognized complication during mandibular third molar surgery, often resulting from excessive traction or manipulation of the lingual flap. The use of periosteal elevators for lingual retraction is a common practice, while corticosteroids such as dexamethasone have been suggested to minimize postoperative inflammation and nerve injury. Objective: To assess the incidence of lingual nerve injury by comparing two surgical approaches—lingual retraction using a periosteal elevator alone versus retraction with a periosteal elevator preceded by preoperative steroid therapy. Study Design: Randomized controlled trial. Setting: Department of Oral and Maxillofacial Surgery, at Sardar Begum Dental College and Hospital, Peshawar, Pakistan. Duration of Study: From 23 February 2025 to 23 May 2025. Methods: A total of 88 patients requiring mandibular third molar extraction were randomly allocated into two groups (n=44 each). Group A underwent lingual flap retraction using only a periosteal elevator. At the same time, Group B received a single intramuscular dose of dexamethasone (4 mg) one hour preoperatively, followed by lingual retraction using a periosteal elevator. Postoperative lingual nerve sensory function was evaluated on the 7th postoperative day using standardized neurosensory tests. Data were analyzed using SPSS version 23, and the chi-square test was used to assess intergroup differences; p < 0.05 was considered significant. Results: The mean age of patients was 35.14 ± 11.08 years in Group A and 41.20 ± 11.89 years in Group B. The incidence of lingual nerve injury was 6.8% in Group A and 2.3% in Group B. The difference between the two groups was not statistically significant (p > 0.05). Conclusion: Preoperative administration of dexamethasone before lingual retraction slightly reduced the incidence of lingual nerve injury following mandibular third molar extraction; however, the difference was not statistically significant. Further studies with larger sample sizes and long-term follow-up are warranted to confirm these findings.

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