SA3 - Clinical Characteristics and Surgical Time Course of Trigeminal Nerve Injury Referrals

Abstract: Purpose: Time is a factor that influences outcomes of trigeminal nerve repair.^1,2 The purpose of this study was to identify clinical features and characterize the time course from injury to surgical intervention in patients referred for trigeminal nerve injury. We hypothesized that the interval from injury to referral would be the primary contributor to delays in surgical treatment.

Study Design: This retrospective case series was composed of consecutive subjects referred for evaluation of trigeminal nerve injury from 2019 to 2024. All referrals during the study period, whether evaluated or not, were included. Subjects were excluded if they had previously been evaluated by a trigeminal nerve surgeon or had previously received trigeminal nerve repair surgery.

Variables: The primary outcome of interest was trigeminal nerve injury to surgery time. Variables used to develop a time sequence from injury to surgery were expressed in days and included: time from referral to first clinic visit, age of injury at first clinic visit, time from first clinic visit to MRN read, and time from first clinic visit to surgery. Demographic characteristics of the subjects included age, sex, insurance status (insured vs uninsured), and location (lives in Texas vs out of state). The specialty of the referring provider was recorded. The etiology of the trigeminal nerve injury was categorized based on the procedure performed when the injury occurred. Categories for the etiology of injury variable included third molar extraction, extraction, implant, injection, orthognathic, endodontic, trauma, pathology, restorative, temporomandibular joint replacement, or not available. We recorded whether magnetic resonance neurography (MRN) was offered. If MRN was offered but not completed, the reason was recorded as cost, accepted prognosis, or no-show for the radiology visit. Similarly, if surgery was offered and not completed, the reason was recorded as accepted prognosis or cost.

Analyses: Frequencies and proportions were calculated for categorical data. Means, ranges, and standard deviations (SD) were calculated for continuous data.

Results: The study sample was composed of 558 subjects. The mean age of the total population in years was 39.9 (range 14-77; SD 15.8). There were 159 (28%) males and 399 (72%) females. There were 167 (30%) subjects referred from outside Texas. A total of 448 (80%) subjects were insured, 51 (9%) were uninsured, and 59 (11%) had unavailable insurance status. The most common referring providers were oral and maxillofacial surgeons (61%), followed by general dentists (21%), and general medicine practitioners (6%). Figure 1 provides a timeline from injury to surgery for the 113 subjects who received trigeminal nerve surgery. The mean injury-to-surgery time was 202.4 days (range 24-1,169; SD 161.1). The mean age of injury at the first visit was 152.1 days (range 6-1,104; SD 149.7). The mean referral-to-first-visit time was 33 days (range 1-132; SD 23.4). The mean time from first visit to MRN read was 21 days (range 0-260; SD 34.1). The mean time from first visit to surgery was 50 days (range 1-268; SD 42.38).

Conclusions: Injury to referral time accounted for 59% of the injury to surgery time course.



References

1. Bagheri SC, Meyer RA, Khan HA, Kuhmichel A, Steed MB. Retrospective review of microsurgical repair of 222 lingual nerve injuries. J Oral Maxillofac Surg. 2010;68(4):715-23. doi: 10.1016/j.joms.2009.09.111.


2. Susarla SM, Kaban LB, Donoff RB, Dodson TB. Does early repair of lingual nerve injuries improve functional sensory recovery? J Oral Maxillofac Surg. 2007;65(6):1070-6. doi: 10.1016/j.joms.2006.10.010