Mandibular Fracture as a Complication of Inferior Alveolar Nerve Transposition and Placement of Endosseous Implants: A Case Report

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Mandibular Fracture as a Complication of Inferior Alveolar Nerve Transposition and Placement of Endosseous Implants: A Case Report
September 2003
Karlis, Vasiliki DMD, MD*; Bae, Richard D. DDS**; Glickman, Robert S. DMD***
*Associate Professor, Program Director, Advanced Education Program, Department of Oral and Maxillofacial Surgery, New York University and Bellevue Hospital Center (NYU/BHC), New York University College of Dentistry (NYUCD), New York, New York.
**Resident, Department of Oral and Maxillofacial Surgery, Department of Veterans Affairs Medical Center, NYU/BHC, NYUCD, New York, NY.
***Professor and Chair, Department of Oral and Maxillofacial Surgery, NYU/BHC, NYUCD, New York, NY.
Reprint requests and correspondence to: Vasiliki Karlis, DMD, MD, Department of Oral and Maxillofacial Surgery, New York University College of Dentistry, 345 East 24th Street, New York, NY 10010
Implant Dentistry: Volume 12(3) September 2003 pp 211-216
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Abstract
Placement of endosseous implants and inferior alveolar nerve transposition is a treatment option for patients with an edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal. Complications associated with these procedures include infection, prolonged neurosensory disturbances, and/or pathologicfracture. This report presents the surgical management of a patient with a mandible fracture after inferior alveolar nerve transposition with concurrent placement of two endosseous implants.
The demand for implant reconstruction is increasing as the population of elderly persons increases and implant-supported prostheses become more desirable. Inferior alveolar nerve (IAN) transposition has made it possible for many patients who were previously not good candidates for implant reconstruction of the atrophic posterior mandible to benefit from these procedures. In 1987, Jensen and Nock 1 reported the first restoration of an atrophic posterior mandible with endosseous implants in conjunction with IAN transposition. The surgical technique of IAN transposition requires an osteotomy of the buccal cortex of the mandible with exposure and lateralization of the inferior alveolar neurovascular bundle. This procedure allows for the engagement of more bone to support implants and reduces the risk of nerve injury from direct implant placement. However, there are a number of possible complications associated with these procedures that must be considered during treatment planning. The most common complication is prolonged neurosensory disturbance due to manipulation of the neurovascular bundle. 2-4 In rare situations, iatrogenic or pathologic fracture of the mandible may occur. 5
This report presents the surgical management of a patient referred to our department with a mandible fracture that developed 4 weeks after IAN transposition and simultaneous placement of endosseous implants.
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