Is a Modified Trigeminal Nerve Injury Grading System Necessary?
Michael Miloro, MD, DMD, FACS, University of Illinois at Chicago, Chicago, IL
Introduction: A variety of nerve injury grading systems have been used to assess sensory function along the terminal branches of the trigeminal nerve, specifically the inferior alveolar (IAN) and lingual nerves (LN). Unfortunately, no currently accepted standard system is ideal, including the Medical Research Council System (MRCS), and this leads to confusion and miscommunication, as well as inconsistent reporting of outcomes. The hypothesis is that a unique classification system is necessary for trigeminal nerve injury assessment, and a modified scale is presented.
Materials and Methods: An electronic survey was sent to Oral and Maxillofacial Surgeons (OMFS) to determine their neurosensory testing (NST) practices and their comfort level with the current protocols, as well as their clinical experience and evaluation of a sample case.
Results: Grading scales used by OMFS include Seddon (25%), Sunderland (63%), MRCS (100%). NST protocols vary considerably including 2PD, BSD, CD, PP, TD. The sample case MRCS grading by respondents was inconsistent. Peri-nerve injury management was variable, and recommendations for microneurosurgical repair time were not consistent. Despite these findings, most OMFS felt adequately prepared to assess IAN/LN injuries, although most OMFS evaluate less than 10 nerve injuries each year. Most OMFS (75%) have had a temporary IAN/LN injury, and only 25% have had a permanent injury, with 50% requiring microsurgical repair. The majority of OMFS feel that an improved trigeminal nerve injury classification system is needed. Based upon these findings, a modified trigeminal nerve injury MRCS is presented.
Conclusions: While most OMFS feel confident in the assessment of trigeminal nerve injuries, there is inconsistency in evaluation methods, and there is agreement that a novel classification system is needed for easier and more efficient patient evaluation and reporting of outcomes in the literature.
Back to 2021 ePosters