Original Article

Role of computer assisted designed and manufactured surgical guide in minimizing inferior alveolar nerve injury during sagittal split ramus osteotomy

Abstract

Background: The surgical guide enabled the surgeon to accurately perform osteotomy, minimize iatrogenic injury to vital structure in vicinity to osteotomy and moving the bony segments to desired position exactly as planned during computer simulation. The purpose of this study is assess the role of computer assisted designed and manufactured surgical guide in minimizing inferior alveolar nerve injury during sagittal split ramus osteotomy (SSRO). Materials and Methods: A prospective double blind, randomized controlled, clinical trial is designed to assess role of computer assisted designed and manufactured surgical guide in minimizing inferior alveolar nerve injury during sagittal split ramus osteotomy (SSRO). We had two study group, the side of mandibular ramus that were treated by conventional SSRO (can be right or left) and the side that was treated using the computer designed and manufactured surgical guide of same patient (can be right or left side). For every patient the side of mandibular and osteotomy technique was selected by simple random sampling technique (double coin tossing). The statistical analyses were performed using SPSS version 25 (statistics package for social sciences, Chicago. IL). Statistical significance threshold was set to 0.05 (p-value<0.05). Result: The study population consisted of 10 subjects undergoing SSRO (Sagittal split ramus osteotomy). Seven (70%) were female and three were male. Their mean (±SD) age was 22.4±3024 yrs., range 16 to 27. The mean (±SD) duration of osteotomy on surgical guide assisted SSRO side was 37.2±4.83 and for conventional SSRO side it was 28.2±4.10 and the difference is statistically significant. Conclusion: Using CAD/CAM surgical guide for SSRO has no significant difference with conventional osteotomy technique regarding minimizing the incidence of inferior alveolar nerve injuries that occurs intraoperatively. Keywords: Sagittal split ramus osteotomy; Surgical guide; Neurosensory disturbance; Computer.
1. Wyatt WM. Sagittal ramus split osteotomy: literature review and suggested modification of technique. Br J Oral Maxillofac Surg. 1997;35(2):137-41.

2. Proffit WR, Phillips C, Tulloch JF, Medland PH. Surgical versus orthodontic correction of skeletal Class II malocclusion in adolescents: effects and indications. The International journal of adult orthodontics and orthognathic surgery. 1992;7(4):209-20.

3. Jones JK, Van Sickels JE. Facial nerve injuries associated with orthognathic surgery: A review of incidence and management. J Oral Maxillofac Surg. 1991;49(7):740-4.

4. Fridrich KL, Holton TJ, Pansegrau KJ, Buckley MJ. Neurosensory recovery following the mandibular bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 1995;53(11):1300-6.

5. Jones DL, Wolford LM, Hartog JM. Comparison of methods to assess neurosensory alterations following orthognathic surgery. The International journal of adult orthodontics and orthognathic surgery. 1990;5(1):35-42.

6. Jones DL, Wolford LM. Intraoperative recording of trigeminal evoked potentials during orthognathic surgery. The International journal of adult orthodontics and orthognathic surgery. 1990;5(3):167-74.
7. Panula K, Finne K, Oikarinen K. Neurosensory deficits after bilateral sagittal split ramus osteotomy of the mandible—influence of soft tissue handling medial to the ascending ramus. Int J Oral Maxillofac Surg. 2004;33(6):543-8.

8. Van Sickels JE, Hatch JP, Dolce C, Bays RA, Rugh JD. Effects of age, amount of advancement, and genioplasty on neurosensory disturbance after a bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 2002;60(9):1012-7.

9. Brusati R, Fiamminghi L, Sesenna E, Gazzotti A. Functional disturbances of the inferior alveolar nerve after sagittal osteotomy of the mandibular ramus: Operating technique for prevention. J Maxillofac Surg. 1981;9:123-5.

10. Turvey TA. Intraoperative complications of sagittal osteotomy of the mandibular ramus: Incidence and management. J Oral Maxillofac Surg. 1985;43(7):504-9.

11. Meyer RA. Protection of the lingual nerve during placement of rigid fixation after sagittal ramus osteotomy. J Oral Maxillofac Surg. 1990;48(10):1135.

12. Haskell R. Medico-legal consequences of extracting lower third molar teeth. Medical Protection Society annual reports and accounts. 1986;94:51-2.

13. Guernsey LH, DeChamplain RW. Sequelae and complications of the intraoral sagittal osteotomy in the mandibular rami. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 1971;32(2):176-92.

14. Walter JM, Gregg JM. Analysis of postsurgical neurologic alteration in the trigeminal nerve. Journal of oral surgery (American Dental Association : 1965). 1979;37(6):410-4.

15. Martis CS. Complications after mandibular sagittal split osteotomy. J Oral Maxillofac Surg. 1984;42(2):101-7.

16. Nishioka GJ, Zysset MK, Van Sickels JE. Neurosensory disturbance with rigid fixation of the bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 1987;45(1):20-6.

17. Leira JI, Gilhuus-Moe OT. Sensory impairment following sagittal split osteotomy for correction of mandibular retrognathism. The International journal of adult orthodontics and orthognathic surgery. 1991;6(3):161-

7.
18. Obwegeser H. The indications for surgical correction of mandibular deformity by the sagittal splitting technique. Br J Oral Surg. 1963;1:157-71.

19. Parthasarathy J, Starly B, Raman S. Computer Aided Biomodeling and Analysis of Patient Specific Porous Titanium Mandibular Implants. J Med Device. 2009;3(3):031007--9.

20. Cansiz E, Turan F, Arslan YZ. Computer-Aided Design and Manufacturing of a Novel Maxillofacial Surgery Instrument: Application in the Sagittal Split Osteotomy. J Med Device. 2016;10(4):044505--4.

21. T. AAH, W. MSM, M. HAu. Evaluation of an innovative computer‐assisted sagittal split ramus osteotomy to reduce neurosensory alterations following orthognathic surgery: a pilot study. The International Journal of Medical Robotics and Computer Assisted Surgery. 2013;9(2):134-41.

22. Kim S-G, Park S-S. Incidence of Complications and Problems Related to Orthognathic Surgery. J Oral Maxillofac Surg. 2007;65(12):2438-44.

23. Westermark A, Bystedt H, von Konow L. Patients' evaluation of the final result of sagittal split osteotomy: is it influenced by impaired sensitivity of the lower lip and chin? The International journal of adult orthodontics and orthognathic surgery. 1999;14(2):135-9.
Files
IssueVol 7, No 4 (Autumn 2020) QRcode
SectionOriginal Article(s)
Published2021-02-21
DOI https://doi.org/10.18502/jcr.v7i4.5556
Keywords
Sagittal split ramus osteotomy; Surgical guide; Neurosensory disturbance; Computer.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Abbasi AJ, Azari A, Momeni M, Shamshiri AR, Megersa Gema S. Role of computer assisted designed and manufactured surgical guide in minimizing inferior alveolar nerve injury during sagittal split ramus osteotomy. J Craniomaxillofac Res. 7(4):203-212.