Using Fibrin Glue to Help Lingual Nerve Repair

An interesting article titled “Use of Fibrin Glue as an Adjunct in the Repair of Lingual Nerve Injury: Case Report,” was written by Nicholas P. Theberge and Vincent B. Ziccardi and appears in the 2016 Journal of Oral and Maxilofacial Surgery (vol. 74, pp. 1899 e1-e4). The article describes a report of a case of a woman in her 20s who had an impacted wisdom tooth removed and developed left lingual nerve numbness and pain. She later had surgery with fibrin glue to help correct the lingual nerve injury.

The article reports that most lingual nerve injuries after wisdom teeth removal occurs in 0.4% to 22% of cases. Such an injury can be detrimental to patients and lead to drooling, tongue biting, self-induced thermal injuries, and changes in speech, swallowing, and taste perception. Lingual nerve deficit has been reported to have the highest incidence in distally impacted lower wisdom teeth, followed by horizontal, mesial, and vertical impactions. When an injury to the lingual nerve occurs full recovery occurs in most patients (58%) within the first 6 months and in 72% patients after 2 years.

The article later describes the specific surgery done on the woman. The nerve was freed with a Dirks dissector for 2 cm proximally and distally to the area of injury and the abnormal-appearing tissue showed a breach and injury at the level of the epineurium, which was repaired with 7-0 nylon suture in a tension-free primary neurorrhaphy. The lingual nerve was entubilized with an AxoGuard. Tisseel fibrin glue was prepared according to the manufacturer’s recommendations and sealed the AxoGuard around the nerve to prevent fibrous ingrowth and maintain stability.

Five months after surgery, the patient reported sensory improvement with improved taste for the distribution of the left lingual nerve. Cold stimuli and vibration returned to normal according to the patient. The patient was pleased with the overall  course and recovery.

Fibrin sealants can decrease the fibrosis and inflammation which occurs with microsuturing techniques, as shown in animal models. In addition, fibrin adhesives have been shown to exhibit better axonal regeneration and fiber alignment than nerves repaired using microsuture. There are limited drawbacks for fibrin glue which includes a remote risk of viral transmission and allergic reaction. The fibrin glue is relatively inexpensive (US $180) and can be used to repair lingual nerve damage although this particular case report is novel.

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