Clinical ArticlesEffects of age, amount of advancement, and genioplasty on neurosensory disturbance after a bilateral sagittal split osteotomy☆,☆☆
Section snippets
Materials and methods
Objective neurosensory evaluations were performed at multiple periods ranging from 2 weeks before surgery to 2 years after surgery. Patients were participating in a multisite randomized, clinical trial at The University of Texas Health Science Center at San Antonio, University of Florida, Gainsville, and Emory University in Atlanta comparing 2 surgical fixation techniques. They were assigned to rigid or wire fixation using a stratified randomized assignment. Three bicortical position screws
Results
In general, there were no differences among the 3 sites of light touch and brush stroke sensitivity scores. As such, all 3 sites were combined. The 3 age groups, 2 genioplasty groups, and 2 advancement groups showed no difference in neurosensory function when tested 2 weeks before surgery (P >.05). These groups also showed no difference in function at the infraorbital site. The postsurgical changes in touch detection threshold and brush stroke direction are displayed (Fig 1).
Discussion
Pratt et al21 compared the labial sensation in 2 groups of patients who underwent a BSSO with either superior border wires or miniplates used to fix the proximal and distal segments. They noted that the incidence of persistent sensory disturbance to be much higher in the group with superior border wires at 2 years. In a previous report from our group, there was no significant difference between inferior border wire and 3 bicortical position screws used to fix the proximal and distal segments
Conclusions
Neurosensory injuries after a BSSO are very common. The vast majority of patients show significant recovery by 2 years after surgery. Age of the patient at the time of surgery and addition of a genioplasty increase the risk of a neurosensory injury. Large advancements further increase the risk of neurosensory injury, especially in older patients.
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2022, Journal of Evidence-Based Dental PracticeCitation Excerpt :Long-term neurologic deficit occurs in 10% to 30% of the affected patients, whether annoyed or not.3 Many factors are involved in IAN NSD such as age, sex, bone quality, surgeon's skills, presence of concomitant genioplasty, dissection technique, bad splits, fixation techniques, presence of the third molar tooth, increased amount of mandibular advancements, laterally positioned mandibular canals, and manipulation of the inferior alveolar nerve.7-12 The introduction of piezosurgery decreases the risk of damage to the surrounding soft tissues and other vital structures; namely nerves, vessels, and mucosa, particularly during an osteotomy.13-18
Computed tomography assessment of mandibular morphologic changes and the inferior mandibular border defect after sagittal split ramus osteotomy
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This study was supported by National Institutes of Health Grants DE 09630 and 07282.
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Address correspondence and reprint requests to Dr Van Sickels: Professor and Director of Residency Education, Division of Oral and Maxillofacial Surgery, D-512 Chandler Medical Center, College of Dentistry, University of Kentucky, Lexington, KY 40536-0297; e-mail: [email protected]