Influence of the anesthetic modality on the development of neurological injury after lower third molar extraction: A systematic review of the literature

The aim of this study is to evaluate if the risk of neurological injury to the inferior alveolar nerve (IAN) and the lingual nerve (LN), following the extraction of lower third molars are influenced by the anesthetic modality (local anesthesia (LA) vs. general anesthesia (GA)). A systematic search was performed through the PubMed, Scopus, Cochrane Library, an Web of Science databases; furthermore, a manual search was performed by analyzing the references of full-text articles. From a total of 309 studies (collected after the removal of duplicates), 6 studies were selected. Of these, 4 reported a correlation between GA and nerve damage, while the other 2 did not show an obvious association. The level of bias in the studies was also calculated. Only 2 studies showed a medium risk of bias, while 4 studies showed a high risk of bias; no study showed a low risk of bias. Four of the 6 studies highlighted a higher incidence of IAN and LN injury, following the extractions performed under GA. Although no scientific evidence is yet available, due to the scarcity and the limited quality of the studies in the literature, considering the risk-benefit ratio, LA should be the first choice in lower third molar surgery.

Automated summary

This study aims to evaluate the influence of anesthetic modality (local anesthesia (LA) vs. general anesthesia (GA)) on the risk of neurological injury during lower third molar extraction. A systematic search identified 6 studies, of which 4 reported a correlation between GA and nerve damage. Two studies did not show an obvious association. Overall, the literature lacks scientific evidence, but based on the risk-benefit ratio, LA should be preferred for lower third molar surgery.