Abstract
The aim of this study was to assess the occurrence of neurosensory disturbance of
the inferior alveolar nerve (IAN) following modified mandibular bilateral sagittal
split osteotomy (BSSO) that preserves the mandibular inferior border. All patients
undergoing BSSO, associated or not with a Le Fort I osteotomy (performed by the same
senior operator) between January 2018 and December 2019, were eligible. The modified
BSSO consists of a modification of the technique described by Epker: the bony section
of the buccal cortex stops 3-4 mm above the basal mandibular edge. While respecting
the basilar border, sectioning is then performed up to the gonial angle where bicortical
section is finally performed. Sensibility of the labial and chin area was evaluated
immediately postoperatively, and at six months and two years of follow up. A total
of 140 eligible patients underwent the modified BSSO between January 2018 and December
2019, and 72 were included. Hypoesthesia was found in 81.9% of the patients (59/72
patients) at initial evaluation. It decreased to 45.8% (33/72 patients) at the six-month
examination and to 12.5% (9/72 patients) at the last examination. Four bad splits
were recorded. The modified BSSO preserves the inferior border of the mandible and
maintains the IAN in the lingual fragment. There is no need to release the IAN, hence
its manipulation is reduced and the incidence of IAN postoperative hypoesthesia is
also reduced.
Keywords
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References
- The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty: part I. Surgical procedures to correct mandibular prognathism and reshaping of the chin.Oral Surg Oral Med Oral Pathol. 1957; 10: 677-689
- Retro-molar osteotomy for correction of prognathism.Minerva Chir. 1959; 14 (In Italian): 1138-1141
- A modified intraoral sagittal splitting technic for correction of mandibular prognathism.J Oral Surg. 1968; 26: 250-253
- Modifications in the sagittal osteotomy of the mandible.J Oral Surg. 1977; 35: 157-159
- Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances.Int J Oral Maxillofac Surg. 2015; 44: 447-451
- Neurosensory disturbances after bilateral sagittal split osteotomy using piezoelectric surgery: a systematic review.J Oral Maxillofac Surg. 2019; 77: 380-390
- Use of bone grafts or modified bilateral sagittal split osteotomy technique in large mandibular advancements reduces the risk of persisting mandibular inferior border defects.J Oral Maxillofac Surg. 2018; 76: 189.e1-189.e6
- Modified mandibular inferior border sagittal split osteotomy reduces postoperative risk for developing inferior border defects.J Oral Maxillofac Surg. 2016; 74: 1062.e1-1062.e9
- Modified mandibular sagittal split osteotomy.J Craniofac Surg. 2019; 30: 897-899
- Neurosensory evaluation of inferior alveolar nerve after bilateral sagittal split ramus osteotomy of mandible.J Oral Biol Craniofac Res. 2017; 7: 81-88
- Risk factors for common complications associated with bilateral sagittal split osteotomy: a literature review and meta-analysis.J Craniomaxillofac Surg. 2016; 44: 1170-1180
- Nerve injury associated with orthognathic surgery. Part 2: inferior alveolar nerve.Br J Oral Maxillofac Surg. 2016; 54: 366-371
- Long-term neurosensory disturbances after modified sagittal split osteotomy.Br J Oral Maxillofac Surg. 2020; 58: 986-991
- Nerve physiology: mechanisms of injury and recovery.Hand Clin. 2013; 29: 317-330
- Inferior alveolar nerve injury following orthognathic surgery: a review of assessment issues.J Oral Rehabil. 2011; 38: 547-554
- Neurosensory function after sagittal split osteotomy of the mandible: a comparison between subjective evaluation and objective assessment.Int J Adult Orthodon Orthognath Surg. 1999; 14: 268-275
- Neurosensory disturbance of the inferior alveolar nerve after bilateral sagittal split osteotomy: a systematic review.J Oral Maxillofac Surg. 2007; 65: 1707-1715
- Sensory retraining: burden in daily life related to altered sensation after orthognathic surgery, a randomized clinical trial.Orthod Craniofac Res. 2010; 13: 169-178
- Inferior alveolar nerve function after sagittal split osteotomy of the mandible: correlation with degree of intraoperative nerve encounter and other variables in 496 operations.Br J Oral Maxillofac Surg. 1998; 36: 429-433
- Neurosensory disturbances one year after bilateral sagittal split osteotomy of the mandibula performed with separators: a multi-centre prospective study.J Craniomaxillofac Surg. 2012; 40: 763-767
- Factors influencing neurosensory disturbance after bilateral sagittal split osteotomy: retrospective analysis after 6 and 12 months.Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 115: 473-482
- Self-reported hypoesthesia of the lower lip after sagittal split osteotomy.Int J Oral Maxillofac Surg. 2013; 42: 823-829
- Neurosensory alterations of the inferior alveolar and mental nerve after genioplasty alone or associated with sagittal osteotomy of the mandibular ramus.J Craniomaxillofac Surg. 2002; 30: 295-303
- Influence of BSSO surgical technique on postoperative inferior alveolar nerve hypoesthesia: a systematic review of the literature.J Craniomaxillofac Surg. 2014; 42: 976-982
- Is injury to the inferior alveolar nerve still common during orthognathic surgery? Manual twist technique for sagittal split ramus osteotomy.Br J Oral Maxillofac Surg. 2018; 56: 946-951
- Attachment rate of the inferior alveolar nerve to buccal plate during bilateral sagittal split osteotomy influences self-reported sensory impairment.J Craniofac Surg. 2014; 25: 2121-2126
- Presence of mandibular third molars during bilateral sagittal split osteotomy increases the possibility of bad split but not the risk of other post-operative complications.J Craniomaxillofac Surg. 2014; 42: e359-e363
- Hypoesthesia associated with mandibular movement after sagittal split ramus osteotomy.Oral Maxillofac Surg. 2017; 21: 313-319
- Relationship between recovery period of lower lip hypoesthesia and sagittal split area or plate screw position after sagittal split ramus osteotomy.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105: 11-15
- Evaluation of factors affecting recovery period in lower lip hypoesthesia after sagittal split ramus osteotomy in mandibular prognathism patients.J Craniomaxillofac Surg. 2014; 42: 1748-1752
- Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors.Int J Oral Maxillofac Surg. 2016; 45: 971-979
- Computed tomography assessment of mandibular morphologic changes and the inferior mandibular border defect after sagittal split ramus osteotomy.Oral Surg Oral Med Oral Pathol Oral Radiol. 2021; 132: 496-505
- Are there risk factors for osseous mandibular inferior border defects after bilateral sagittal split osteotomy?.J Craniomaxillofac Surg. 2017; 45: 192-197
Article Info
Publication History
Published online: April 13, 2022
Accepted:
April 1,
2022
Received in revised form:
March 14,
2022
Received:
January 20,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
