The impact of altered sensation affecting the lower lip after orthognathic treatment.

PURPOSE: Inferior dental nerve paresthesia is a well-known risk of orthognathic surgery, but little is known about the effects of altered sensation in day-to-day life. Therefore the aim of this study was to assess the impact of altered sensation after orthognathic treatment. PATIENTS AND METHODS: The study was divided into 2 parts: the first phase involved semistructured, in-depth interviews with 13 post-treatment orthognathic patients who presented with altered sensation affecting the lower lip. In the second part of the study, the data from the interviews were used to develop a questionnaire that was distributed to 40 post-orthognathic patients (75% completion [n = 30]). The results were analyzed by use of descriptive statistical methods. RESULTS: In both stages of the study, common descriptors used to describe the altered sensation were "tingling" and "numb." The majority of patients were aware of the neurosensory disturbance when touching their lips, face, or jaw, and patients also expressed difficulties knowing when food was left on their lip. It was noted that patients who were aware of the altered sensation all of the time expressed the greatest distress in their everyday life. When it came to emotions associated with the altered sensation, the majority of patients were disappointed, but few were upset or angry. CONCLUSIONS: The impact of altered sensation due to inferior dental nerve damage after orthognathic surgery varied from patient to patient, but altered sensation had a significant effect on the majority of patients' everyday lives. The information obtained from this study makes an important contribution to the informed consent process.

A new style of orthognathic clinic.

The Orthognathic Team at the Eastman Dental Hospital has developed a new style of multidisciplinary clinic to supplement the traditional orthognathic consultation. The aim of the new clinic is to increase patient satisfaction and involvement in the consent and decision making process, as well as optimizing the information given to prospective patients regarding all aspects of this complex elective treatment. Results of a survey of patients attending the clinic found that 80% thought that the information given was 'just the right amount' and 96% were satisfied with the new structure. They particularly found it useful to meet a patient who had completed treatment. All of those who attended said that they understood the information given to them and would recommend the clinic to those considering orthognathic treatment. They also liked having other patients there with them on the clinic.

A Missed Case of Occult Bilateral Temporomandibular Dislocation Mistaken for Dystonia.

A 24-year-old male with a history of psychiatric disorder and no prior significant temporomandibular joint (TMJ) pathology presented to the emergency department for "lockjaw." Plain film X-rays of the mandible were read as unremarkable by an attending radiologist, leading to the initial diagnosis of medication-induced dystonic reaction. Following unsuccessful medical treatment a maxillofacial computed tomography (CT) was ordered. CT confirmed bilateral dislocation, illustrating the importance of clinical judgment, and limitations of certain radiographic images. The authors believe this case to be the first reported case in the medical literature of bilateral anterior TMJ dislocation with a false negative X-ray.