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Effect of modified bilateral sagittal split osteotomy on inferior alveolar nerve neurosensory disturbance

  • Matthias Schlund
    Correspondence
    Corresponding author at: Service de Chirurgie Maxillo-Faciale et Stomatologie, Centre François-Xavier Michelet, Groupe Hospitalier Pellegrin, CHU Bordeaux, Place Amélie Raba-Léon, Bordeaux, France.
    Affiliations
    Univ. Bordeaux, CHU Bordeaux, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, BioTis - Bioengineering of Tissues Inserm U1026, F-33000 Bordeaux, France
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  • Patrick Grall
    Affiliations
    Univ. Lille, CHU Lille, Service de Chirurgie Maxillo-Faciale et Stomatologie, F-59000 Lille, France
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  • Joël Ferri
    Affiliations
    Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 – Controlled Drug Delivery Systems and Biomaterial, F-59000 Lille, France
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  • Romain Nicot
    Affiliations
    Univ. Lille, CHU Lille, INSERM, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008 – Controlled Drug Delivery Systems and Biomaterial, F-59000 Lille, France
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      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.

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