ABSTRACT
Bilateral sagittal split osteotomy (BSSO) is an effective and commonly used treatment to correct mandibular hypo- and hyperplasia. Hypoesthesia of the inferior alveolar nerve (IAN) is a common complication of this surgical procedure. This prospective multi-centre study aimed to determine the incidence of neurosensory disturbances of the IAN after BSSO procedures performed without the use of chisels. Our study group comprised 158 patients, with a follow-up period of 1 year, who underwent BSSO (with or without Le Fort I) that incorporated the use of sagittal split separators and splitters but no chisels. The percentage of BSSO split procedures that resulted in IAN damage was 5.1%. The percentage of patients (without genioplasty) who experienced IAN damage was 8.9%. The concomitant genioplasty in combination with BSSO was significantly associated with hypoesthesia. Peri-operative removal of the wisdom tooth or a Le Fort I procedure did not influence post-operative hypoesthesia. We believe that the use of splitting forceps and elevators without chisels leads to a lower incidence of persistent post-operative hypoesthesia 1 year after BSSO of the mandible, without increasing the risk of a bad split.
Subject(s)
Cranial Nerve Diseases/etiology , Hypesthesia/etiology , Mandible/surgery , Mandibular Nerve/physiopathology , Osteotomy, Sagittal Split Ramus/adverse effects , Adolescent , Adult , Age Factors , Bone Screws , Cheek/innervation , Chin/surgery , Female , Follow-Up Studies , Forehead/innervation , Humans , Lip/innervation , Male , Mandible/innervation , Mandibular Advancement/adverse effects , Mandibular Advancement/instrumentation , Middle Aged , Molar, Third/surgery , Osteotomy, Le Fort/methods , Osteotomy, Sagittal Split Ramus/instrumentation , Prospective Studies , Tooth Extraction/methods , Touch/physiology , Trigeminal Nerve Injuries/etiology , Young AdultABSTRACT
BACKGROUND: The most frequently performed osteotomy for correction of mandibular retrognathia is a bilateral sagittal split ramus osteotomy. Permanent neurosensory disturbance of the inferior alveolar nerve is one of the most frequently and severe complications. Many authors have reported this, but the incidence differs widely. In the recent literature, only four authors have reported a percentage of less than 10% after 1 year follow-up. OBJECTIVE: To determine the incidence of permanent neurosensory disturbance of the inferior alveolar nerve after bilateral sagittal split ramus osteotomy, and possible influences of the technique used. PATIENTS AND METHODS: A series of 109 patients is reported who underwent a bilateral sagittal split mandibular ramus osteotomy with the use of separators and without the use of chisels. The segments were hold by rigid transbuccal screw fixation. RESULTS: The incidence of neurosensory disturbances 1 year after surgery was 8.3%. CONCLUSION: The use of sagittal split separators without the use of chisels, may play an important role in the relatively low percentage of persistent hypoaesthesia of the inferior alveolar nerve.