The influence of periosteal osteosynthesis on the course of inferior alveolar nerve neuropathy in mandibular fractures

The aim of study — to investigate the impact of inferior alveolar canal (IAC) injury caused by a fixation screw during titanium plate osteosynthesis on the recovery of inferior alveolar nerve (IAN) function. Materials and methods. A prospective cohort study was conducted involving 142 patients from the maxillofacial surgery department with mandibular fractures treated with titanium plate osteosynthesis between 2019 and 2023. Neurosensory disturbances of the IAN were assessed using the DN4 questionnaire and skin electroexcitability parameters. The recovery of IAN function following mandibular osteosynthesis was analyzed using the Kaplan—Meier method and Cox proportional hazards regression analysis. Results. The median recovery time of IAN function was 3 months in the group without IAC injury and 12 months in the group with IAC injury. The probability of IAN function recovery was 3.6 times higher (95% CI: 2.2–5.8) in patients without IAC injury compared to those with IAC injury (p<0.001). Conclusions. Mandibular canal injury by screws during osteosynthesis significantly affects the time required for the recovery of inferior alveolar nerve function. Osteosynthesis for mandibular fractures is an additional risk factor for inferior alveolar nerve damage and requires improved precision in positioning the fixation elements to reduce the risk of postoperative complications.