Evaluation of Neurosensory Disturbance Following Orthognathic Surgery: A Prospective Study

Abstract

Aim and Objectives The prospective study was to evaluate the incidence, type of neurosensory disturbance (NSD), grade its severity and monitor its recovery occurring in the lower lip and chin due to damage to inferior alveolar nerve following orthognathic surgery involving mandible. Materials and Methods The study included 10 patients who have undergone sagittal split osteotomy, genioplasty, and anterior subapical osteotomy (ASO). All the patients examined preoperatively and post operatively 1 week, 1 and 6 months according to standardized test to clarify the subjective and objective neurosensory status of the injured nerve. Pin prick test, blunt test, two-point discrimator test, brush stoke direction, light touch test, warm and cold test were used bilaterally to lower lip and chin area. Results Seven patients underwent bilateral sagittal split osteotomy (BSSO) (70 %), one patient had BSSO with genioplasty (10 %), two patients had BSSO with ASO (20 %). During the operation none of the nerves were transectioned, in 60 % of patients nerve was not visible and in 40 % of patients nerve was seen in distal segment. 70 % of patients underwent setback, 30 % of patients underwent advancement. The subjective evaluation of the patients revealed the incidence of 90 % at 1 week, 30 % at 1 month, 20 % at 6 months and 10 % at 1 year post operatively. The altered sensation reported subjectively was hypoesthesia in 50 % of the patients, anaesthesia in 40 % of the patients.There was 100 % recovery in advancement cases and 93.5 % recovery in setback cases. Conclusion There is a high incidence of NSD of the lower lip and chin after BSSO related to advancement, setback, intraoperative nerve encounter and surgical skill. However, recovery of sensation occurs with increasing frequency during the follow-up period. The clinical neurosensory tests are effective guides to study the neurosensory deficit.

Neuropathy of Trigeminal Nerve Branches After Oral and Maxillofacial Treatment

“…This finding agrees with previous studies, which show hypoesthesia as the commonest sensory disturbance after BSSO, endodontic treatment, local anaesthesia injection and post-procedural inflammatory process [21][22][23][24].…”

“…2). Nerve damage resulting from trauma, local anaesthesia and endodontics result in transient nerve damage recovering over time [21,24,25].…”

The Assessment of Neurosensory Disturbance Following Bilateral Sagittal Split Osteotomy With Subjective and Three-Dimensional Evaluation

“…8,9,11,2 The present study aimed to assess the IAND with subjective tests and its relationship with 3D measurements of MC and fixation screws to evaluate the sensory loss following orthognathic surgery. In the literature, although there are studies reporting no significant difference between mandibular advancement or set-back surgeries with regard to IAND, 9,14,25 since the mechanism for damage (compression/stretching) is different, only the patients operated with mandibular setback surgery were included in the present study. Also, the contradictory results of genioplasty on IAND was effective in not including patients with genioplasty in the present study.…”

“…There are studies evaluating IAND in the 1st, 3rd, and 6th months postoperatively, 11,12,25,27,33,34 however, according to Colella et al 35 incorrect results may occur before the postoperative first year. Therefore, patients were invited to the clinic for subjective evaluation at least 1 year after the surgery (20.43 ± 8.76 months on average) in the present study.…”

Patient related outcomes and improvements in quality of life following orthognathic surgery

“…Further studies are required to explore this relationship, as neurosensory disturbances after orthognathic surgery are relatively common and may affect patient QOL. 39,40…”