Evaluation Of Intraoperative Inferior Alveolar Nerve Exposure During And Postoperative Neurosensory Disturbances After Bilateral Sagittal Split Osteotomy: A Prospective Cross-Sectional Study In Iran
Abstract
Introduction: Inferior alveolar nerve (IAN) exposure and neurosensory disturbances (NSDs) following bilateral sagittal split osteotomy (BSSO) of the mandible are paramount. We aimed to assess intraoperative IAN exposure during and NSDs after BSOO surgery using different clinical assessment methods in a prospective study in a local setting.Materials and Methods: The present study was a prospective cross-sectional study. We monitored the nerve exposure status during the BSSO. Our time points were: before surgery, one day after, one month later, three months after and six months after the BSSO surgery. We performed two-point discrimination test, static light touch test and pinprick test on both mental regions of the cases.Results: We included seven women and eight men. The average age of the participants was 25.13±3.27 years. The results of the two-point discrimination test showed the following: the day after the BSSO compared to before the surgery, the sensation is significantly impaired in both mental regions. In addition, it is noted that during our study, the two-point discrimination test results showed a gradient healing, though not reaching the point before the surgery (P>0.05). The results of the Pinprick test also showed a gradual resolution of the NSDs; however, a significant sensation difference remained between six months after the BSSO and before the surgery.Conclusion: The BSSO surgery significantly impairs the IAN sensation, causing intraoperative IAN exposure and postoperative NSDs for the patients. A gradient resolution of the NSDs was observed in all the cases, though; the sensation of the mental region did not reach the pre-surgical levels.Keywords: Alveolar nerve; Nerve exposure; Neurosensory disturbance; Sagittal split osteotomy surgery.
1. Colella G, Cannavale R, Vicidomini A, Lanza A. Neurosensory disturbance of the inferior alveolar nerve after bilateral sagittal split osteotomy: a systematic review. J Oral Maxillofac Surg. 2007;65(9):1707-15.
2. Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain. 2011;25(4):333-44.
3. Watzke IM: Sagittal Split Osteotomy. In: Fonseca RJ, Marciani RD, Turvey TA, editors: Oral and Maxillofacial Surgery, 2nd Edition, Vol III,. pp. 298-310, St. Louis: Saunders Elsevier, 2009
4. 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.
5. Agbaje JO, Gemels B, Salem AS, Anumendem D, Vrielinck L, Politis C. Modified Mandibular Inferior Border Sagittal Split Osteotomy Reduces Postoperative Risk for Developing Inferior Border Defects. J Oral Maxillofac Surg. 2016;74(5):1062.e1-9.
6. da Costa Senior O, Gemels B, Van der Cruyssen F, Agbaje JO, De Temmerman G, Shaheen E, et al. Long-term neurosensory disturbances after modified sagittal split osteotomy. Br J Oral Maxillofac Surg. 2020;58(8):986-91.
7. Naples R, Van Sickels J, Jones D. Long-term neurosensory deficits associated with bilateral sagittal split osteotomy versus inverted ‘L’osteotomy. Oral Surg, Oral Med Oral Pathol. 1994;77(4):318-21.
8. Böckmann R, Meyns J, Dik E, Kessler P. The modifications of the sagittal ramus split osteotomy: a literature review. Plastic Reconst Surg Global open. 2014;2(12).
9. Yamauchi K, Takahashi T, Kaneuji T, Nogami S, Yamamoto N, Miyamoto I, et al. Risk factors for neurosensory disturbance after bilateral sagittal split osteotomy based on position of mandibular canal and morphology of mandibular angle. J Oral Maxillofacial Surg. 2012;70(2):401-6.
10. Al-Bishri A, Barghash Z, Rosenquist J, Sunzel B. Neurosensory disturbance after sagittal split and intraoral vertical ramus osteotomy: as reported in questionnaires and patients’ records. Int J Oral Maxillofacial Surg. 2005;34(3):247-51.
11. Epker BN. Modifications in the sagittal osteotomy of the mandible. J Oral Surg. 1977;35(2):157-9.
12. Antony P, Sebastian A, Varghese KG, Sobhana C, Mohan S, Soumithran C, et al. Neurosensory evaluation of inferior alveolar nerve after bilateral sagittal split ramus osteotomy of mandible. J Oral Biol Craniofacial Res. 2017;7(2):81-8.
13. Ghali G, Epker BN. Clinical neurosensory testing: practical applications. J Oral Maxillofacial Surg. 1989;47(10):1074-8.
14. Gennaro P, Giovannoni ME, Pini N, Aboh IV, Gabriele G, Iannetti G, et al. Relationship between the quantity of nerve exposure during bilateral sagittal split osteotomy surgery and sensitive recovery. J Craniofacial Surg. 2017;28(5):1375-9.
15. Althagafi A, Nadi M. Acute nerve injury. 2019.
16. Miloro M. Trigeminal nerve injuries: Springer; 2013.
17. Becelli R, Renzi G, Carboni A, Cerulli G, Gasparini G. Inferior alveolar nerve impairment after mandibular sagittal split osteotomy: an analysis of spontaneous recovery patterns observed in 60 patients. J Craniofacial Surg. 2002;13(2):315-20.
18. Ferdousi AM, MacGregor A. The response of the peripheral branches of the trigeminal nerve to trauma. Int J Oral Surg. 1985;14(1):41-6.
19. Ylikontiola L, Kinnunen J, Oikarinen K. Factors affecting neurosensory disturbance after mandibular bilateral sagittal split osteotomy. J Oral Maxillofacial Surg. 2000;58(11):1234-9.
20. Haghighat A. KS, Ghoreishian M. Evaluating the Healing of the Inferior Alveolar Nerve using BlinkReflex and Clinical Nerve Tests Pre-operatively, and Six months after Bilateral Sagittal Split Osteotomy of the Mandible. Res in Med. 2003;4(8):142-5.
21. Shaban B, Kazemian M. Evaluation of temporary neurosensory changes of lower lip following Bilateral Sagittal Split Osteotomy. J Mashhad Dent School. 2011;34(4):309-16.
22. Schultze-Mosgau S, Krems H, Ott R, Neukam FW. A prospective electromyographic and computer-aided thermal sensitivity assessment of nerve lesions after sagittal split osteotomy and Le Fort I osteotomy. J Oral Maxillofacial Surg. 2001;59(2):128-38.
23. Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF. The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofacial Surg. 1998;56(1):2-8.
24. Ylikontiola L, Vesala J, Oikarinen K. Repeatability of 5 clinical neurosensory tests used in orthognathic surgery. Int J Adult Orthodontics Orthognathic Surg. 2001;16(1):36-46.
2. Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain. 2011;25(4):333-44.
3. Watzke IM: Sagittal Split Osteotomy. In: Fonseca RJ, Marciani RD, Turvey TA, editors: Oral and Maxillofacial Surgery, 2nd Edition, Vol III,. pp. 298-310, St. Louis: Saunders Elsevier, 2009
4. 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.
5. Agbaje JO, Gemels B, Salem AS, Anumendem D, Vrielinck L, Politis C. Modified Mandibular Inferior Border Sagittal Split Osteotomy Reduces Postoperative Risk for Developing Inferior Border Defects. J Oral Maxillofac Surg. 2016;74(5):1062.e1-9.
6. da Costa Senior O, Gemels B, Van der Cruyssen F, Agbaje JO, De Temmerman G, Shaheen E, et al. Long-term neurosensory disturbances after modified sagittal split osteotomy. Br J Oral Maxillofac Surg. 2020;58(8):986-91.
7. Naples R, Van Sickels J, Jones D. Long-term neurosensory deficits associated with bilateral sagittal split osteotomy versus inverted ‘L’osteotomy. Oral Surg, Oral Med Oral Pathol. 1994;77(4):318-21.
8. Böckmann R, Meyns J, Dik E, Kessler P. The modifications of the sagittal ramus split osteotomy: a literature review. Plastic Reconst Surg Global open. 2014;2(12).
9. Yamauchi K, Takahashi T, Kaneuji T, Nogami S, Yamamoto N, Miyamoto I, et al. Risk factors for neurosensory disturbance after bilateral sagittal split osteotomy based on position of mandibular canal and morphology of mandibular angle. J Oral Maxillofacial Surg. 2012;70(2):401-6.
10. Al-Bishri A, Barghash Z, Rosenquist J, Sunzel B. Neurosensory disturbance after sagittal split and intraoral vertical ramus osteotomy: as reported in questionnaires and patients’ records. Int J Oral Maxillofacial Surg. 2005;34(3):247-51.
11. Epker BN. Modifications in the sagittal osteotomy of the mandible. J Oral Surg. 1977;35(2):157-9.
12. Antony P, Sebastian A, Varghese KG, Sobhana C, Mohan S, Soumithran C, et al. Neurosensory evaluation of inferior alveolar nerve after bilateral sagittal split ramus osteotomy of mandible. J Oral Biol Craniofacial Res. 2017;7(2):81-8.
13. Ghali G, Epker BN. Clinical neurosensory testing: practical applications. J Oral Maxillofacial Surg. 1989;47(10):1074-8.
14. Gennaro P, Giovannoni ME, Pini N, Aboh IV, Gabriele G, Iannetti G, et al. Relationship between the quantity of nerve exposure during bilateral sagittal split osteotomy surgery and sensitive recovery. J Craniofacial Surg. 2017;28(5):1375-9.
15. Althagafi A, Nadi M. Acute nerve injury. 2019.
16. Miloro M. Trigeminal nerve injuries: Springer; 2013.
17. Becelli R, Renzi G, Carboni A, Cerulli G, Gasparini G. Inferior alveolar nerve impairment after mandibular sagittal split osteotomy: an analysis of spontaneous recovery patterns observed in 60 patients. J Craniofacial Surg. 2002;13(2):315-20.
18. Ferdousi AM, MacGregor A. The response of the peripheral branches of the trigeminal nerve to trauma. Int J Oral Surg. 1985;14(1):41-6.
19. Ylikontiola L, Kinnunen J, Oikarinen K. Factors affecting neurosensory disturbance after mandibular bilateral sagittal split osteotomy. J Oral Maxillofacial Surg. 2000;58(11):1234-9.
20. Haghighat A. KS, Ghoreishian M. Evaluating the Healing of the Inferior Alveolar Nerve using BlinkReflex and Clinical Nerve Tests Pre-operatively, and Six months after Bilateral Sagittal Split Osteotomy of the Mandible. Res in Med. 2003;4(8):142-5.
21. Shaban B, Kazemian M. Evaluation of temporary neurosensory changes of lower lip following Bilateral Sagittal Split Osteotomy. J Mashhad Dent School. 2011;34(4):309-16.
22. Schultze-Mosgau S, Krems H, Ott R, Neukam FW. A prospective electromyographic and computer-aided thermal sensitivity assessment of nerve lesions after sagittal split osteotomy and Le Fort I osteotomy. J Oral Maxillofacial Surg. 2001;59(2):128-38.
23. Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF. The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofacial Surg. 1998;56(1):2-8.
24. Ylikontiola L, Vesala J, Oikarinen K. Repeatability of 5 clinical neurosensory tests used in orthognathic surgery. Int J Adult Orthodontics Orthognathic Surg. 2001;16(1):36-46.
| Files | ||
| Issue | Vol 10, No 4 (Autumn 2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jcr.v10i4.15309 | |
| Keywords | ||
| Alveolar nerve Nerve exposure Neurosensory disturbance Sagittal split osteotomy surgery | ||
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How to Cite
1.
Haghighat A, Moradi F. Evaluation Of Intraoperative Inferior Alveolar Nerve Exposure During And Postoperative Neurosensory Disturbances After Bilateral Sagittal Split Osteotomy: A Prospective Cross-Sectional Study In Iran. J Craniomaxillofac Res. 2024;10(4):172-177.
