RESUMEN
This study compares the effects of bilateral sagittal split osteotomy (BSSO) and distraction osteogenesis (DO) for lengthening the mandible regarding loss of function of the inferior alveolar nerve (IAN). In a retrospective cohort study design, the function of the IAN was tested with a Weinstein monofilament 3.22, 1 year after the surgical procedure in 65 patients (35 BSSO; 30 DO). This was defined as the upper limit for normal function. Of 130 IAN studied (70 BSSO, 54%; 60 DO, 46%), nerve function was disturbed in 23 (18%). In this group, 14 cases (61%) had undergone BSSO and 9 (39%) DO. One-hundred and seven nerves had no neurosensory IAN changes; of these BSSO had been performed in 56 cases (52%) and DO in 51 cases (48%). After eliminating confounding factors, there was no significant difference in the occurrence of neurosensory changes between the treatment options (DO versus BSSO, odds ratio: 1.254 with 95% CI: 0.366-4.300). In conclusion, there was no difference in IAN function between patients treated with BSSO or DO for lengthening the mandible.
Asunto(s)
Mandíbula/cirugía , Avance Mandibular/efectos adversos , Avance Mandibular/métodos , Trastornos Somatosensoriales/etiología , Traumatismos del Nervio Trigémino , Adulto , Distribución por Edad , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Humanos , Técnicas de Fijación de Maxilares , Modelos Logísticos , Masculino , Mandíbula/anomalías , Persona de Mediana Edad , Osteogénesis por Distracción/efectos adversos , Osteotomía/efectos adversos , Retrognatismo/cirugía , Estudios Retrospectivos , Distribución por Sexo , Adulto JovenRESUMEN
Cocaine is a very potent vasoconstrictor that is used by ENT specialists to reduce blood loss and enhance visibility during nasal surgery. In orthognathic surgery, especially Le Fort I procedures, excessive blood loss is a relatively frequent complication. In this study, a prospective randomized clinical trial on the effect on blood loss of cocaine/adrenaline application to the nasal floor is presented. Thirty patients who underwent a Le Fort I procedure were randomized for cocaine/adrenaline application. Blood loss and duration of surgery were registered for both groups. The results showed a significant reduction of blood loss in the group with cocaine/adrenaline application (P<0.001), but no significant difference in operating time. No side effects were observed. From this study, it can be concluded that the application of cocaine/adrenaline to the nasal floor is a safe procedure to reduce blood loss during a Le Fort I procedure.