Neurosensory disturbances one year after bilateral sagittal split osteotomy of the mandibula performed with separators: A multi-centre prospective study

• Published in: Journal of cranio-maxillo-facial surgery 2012-12, Vol.40 (8), p.763-767
• Main Authors: Mensink, Gertjan, Zweers, Albert, Wolterbeek, Ron, Dicker, Gertjan (G.J.), Groot, Robert H, van Merkesteyn, Richard (J.P.R.)
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Bilateral sagittal split osteotomy; Bone Screws; Cheek - innervation; Chin - surgery; Chisels; Cranial Nerve Diseases - etiology; Dentistry; Female; Follow-Up Studies; Forehead - innervation; Humans; Hypesthesia - etiology; Inferior alveolar nerve; Lip - innervation; Male; Mandible - innervation; Mandible - surgery; Mandibular Advancement - adverse effects; Mandibular Advancement - instrumentation; Mandibular Nerve - physiopathology; Middle Aged; Molar, Third - surgery; Neurosensory disturbances; Osteotomy, Le Fort - methods; Osteotomy, Sagittal Split Ramus - adverse effects; Osteotomy, Sagittal Split Ramus - instrumentation; Prospective Studies; Surgery; Tooth Extraction - methods; Touch - physiology; Trigeminal Nerve Injuries - etiology; Young Adult
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2012.02.003

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.