Postsurgical improvement of inferior alveolar nerve in BRONJ assessed by masseter inhibitory reflex

Abstract: The aim of our study was to determine and quantify the presence of presurgical and postsurgical alveolar nerve impairment in a patient affected by mandibular bisphosphonate-related osteonecrosis of the jaw (BRONJ) treated with surgical excision of necrotic mandibular bone. Inferior alveolar nerve (IAN) function was studied through masseter inhibitory reflex (MIR) in preoperative and in postoperative time. To evaluate the diagnostic accuracy of MIR, we measure only the early SP1 component, which is far more accurate than the long-latency response SP2. The surgical treatment was performed by removing the necrotic fragments of bone by manual osteotomies. The MIR in preoperative time was within the normal range, but the latency was longer on the affected than on the normal side. The MIR on the affected side improved after surgical treatment. Neurophysiologic and quantitative sensory testing can quantify the entity of IAN impairment in patients affected by mandibular BRONJ. These tests could also be used in the future for an early diagnosis that may allow surgeons to manage IAN lesions at an early stage, preventing further impairment.