Is It Necessary to Free the Inferior Alveolar Nerve From the Proximal Segment in the Sagittal Split Osteotomy?

The Low Medial Horizontal Osteotomy in Patients With Atypical Ramus Morphology Undergoing Sagittal Split Osteotomy

“…In all cases in which the IAN was contained within the proximal segment, no further attempts were made to free it from the proximal segment. 20 No visible lingual nerve injuries occurred intraoperatively, and no lingual nerve neurosensory deficits were found postoperatively. All patients achieved FSR of the IAN by 1 year postoperatively.…”

“…), with the ipsilateral supraorbital nerve distribution as a positive control. [20][21][22] The Medical Research Council (MRC) scale for FSR ranges from S0 (no recovery, no sensory response) to S4 (complete recovery), with scores of S3 (superficial pain without hyperesthesia; light touch; 2-point discrimination, 16 to 20 mm), S3+ (S3 with 2-point discrimination, 7 to 15 mm), S4 (S4+ with 2-point discrimination <7 mm) defined as FSR. Serial measurements of the positive control side were used to ensure reliability (intraclass correlation coefficient for all domains $0.96; P < .001).…”

“…Serial measurements of the positive control side were used to ensure reliability (intraclass correlation coefficient for all domains $0.96; P < .001). 20 The institutional board approved the present study (approval no. 00002308).…”

“…9,10,19 One consequence of keeping the medial ramus osteotomy low is that the IAN might be more likely to be contained within the proximal segment or injured. 9,10,19,20 In an analysis of a large series of SSOs in patients with primary dentofacial deformities without associated craniofacial anomalies, Posnick et al 19 reported no unfavorable splits of the proximal segment when using a low medial horizontal osteotomy.…”

“…Our specific aims were to 1) identify a cohort of patients undergoing SSO with a low medial horizontal osteotomy, 2) evaluate the osteotomies for unfavorable proximal and distal segment fractures, 3) report the frequency of the IAN being contained within the proximal segment, and 4) measure the functional sensory recovery (FSR) of the IAN. [20][21][22] Patients and Methods…”