An evaluation of clinical and electrophysiologic tests in nerve injury diagnosis after mandibular sagittal split osteotomy

• Published in: International journal of oral and maxillofacial surgery 2003-02, Vol.32 (1), p.15-23
• Main Authors: Teerijoki-Oksa, T, Jääskeläinen, S, Forssell, K, Virtanen, A, Forssell, H
• Format: Article
• Language: English
• Subjects: Action Potentials - physiology; Adolescent; Adult; Blinking - physiology; Cold Temperature; Cranial Nerve Diseases - diagnosis; Cranial Nerve Diseases - etiology; Dentistry; Electric Stimulation; electrodiagnosis; Electromyography; Female; Follow-Up Studies; Humans; inferior alveolar nerve; Intraoperative Care; Male; Mandible - surgery; Mandibular Nerve - physiopathology; Middle Aged; Nerve Fibers - physiology; nerve injury; Neural Conduction - physiology; Osteotomy - adverse effects; Osteotomy - methods; sagittal split osteotomy; Sensation Disorders - diagnosis; Sensation Disorders - etiology; Sensitivity and Specificity; sensory tests; Sensory Thresholds - physiology; Statistics as Topic; Touch - physiology; trigeminal nerve; Trigeminal Nerve Injuries
• ISSN: 0901-5027; 1399-0020
• DOI: 10.1054/ijom.2002.0325

The yield of clinical sensory tests and electrophysiologic tests in the diagnostics of inferior alveolar nerve (IAN) damage after bilateral sagittal split osteotomy (BSSO) was studied. The diagnostic value of these tests was evaluated by comparing the test results to the degree of nerve damage at the end of the operation as documented by means of the intraoperative nerve conduction recording of the IAN. Twenty patients undergoing BSSO were analysed preoperatively and 2 weeks postoperatively. The frequency of the IAN disturbance ranged from 10% to 94% depending on the test method and the test site used. Of the clinical sensory tests, the touch detection threshold (TD) test was the most sensitive and clinically useful test. It also correlated best with the electrophysiologically verified intraoperative nerve damage (R=−0.603,P =0.017 on the right, R=−0.626, P=0.01 on the left). The blink reflex and quantitative cold detection threshold tests were almost as often abnormal as the TD-test, but nerve conduction study (NCS) was the most sensitive (88%) of all clinical and electrophysiologic tests. The frequency of abnormal findings in the electrophysiologic tests indicating IAN injury, 75% on the right side and 90% on the left side, corresponded exactly with the figures of subjective sensory alteration. Almost all electrophysiologic tests showed obvious associations with the objectively verified IAN damage. All tests, except the NCS, showed only moderate sensitivity. Specificity of the tests was generally high, the only exceptions being the TD test and the NCS. To increase the diagnostic accuracy of the testing and to detect different types of damage in different nerve fibre populations, a combination of different sensory and electrophysiologic tests is recommended.