Lingual nerve injury as a complication of rigid fixation of the sagittal ramus osteotomy: Report of a case

Hegtvedt, Arden K.; Zuniga, John R.

doi:10.1016/s0278-2391(10)80485-9

Cited by 20 publications

(8 citation statements)

References 17 publications

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“…I ntroduction of RIF is widely considered an important factor in the development of orthognathic surgery, as indicated by many experiences previously reported. [3][4][5][6][7][8][9]12,13 The advantages of RIF are attributable to the early mobilization of the mandible and include decreased risk of relapse or condylar atrophy, better airway control, improved oral hygiene, and better oral intake. [3][4][5][6][7][8][9] Moreover, previous studies comparing the stability of RIF to osteosynthesis wires and maxillomandibular fixation assessed an improved short-term stability when RIF is used, 10,14,15 although the longterm stability remains a matter of debate.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9]12,13 The advantages of RIF are attributable to the early mobilization of the mandible and include decreased risk of relapse or condylar atrophy, better airway control, improved oral hygiene, and better oral intake. [3][4][5][6][7][8][9] Moreover, previous studies comparing the stability of RIF to osteosynthesis wires and maxillomandibular fixation assessed an improved short-term stability when RIF is used, 10,14,15 although the longterm stability remains a matter of debate. [16][17][18][19] Several aspects should be considered when bicortical screw fixation after BSSO is planned: (1) optimal occlusal stability obtained with orthodontic treatment and assessed with dental cast study; (2) experienced operator and adequate surgical technique of insertion 20 ; (3) once fixation is completed, correct stability of the hardware should be verified during surgery with passive mandibular movements; and (4) assiduous postoperative clinical analysis and assessment of medication regimens so that prompt drainage of hematomas can be performed, infections can be diagnosed in a timely manner, and assesment of fixation stability can be carried out.…”

Section: Discussionmentioning

confidence: 99%

“…As previously reported in the literature, bicortical screw fixation after bilateral sagittal split osteotomy (BSSO) allows immediate mobilization of the mandible and an early return to social life. [3][4][5][6][7][8][9] Various aspects of orthognathic surgery were analyzed in many previous studies, and complications related to RIF fixation after BSSO were reported only incidentally. [7][8][9] Although the advantages of bicortical screw fixation of the mandible in orthognathic surgery were extensively examined, the complications of bicortical screw fixation after BSSO are poorly documented in literature.…”

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confidence: 99%

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Complications of Bicortical Screw Fixation Observed in 482 Mandibular Sagittal Osteotomies

Becelli¹,

Fini²,

Renzi³

et al. 2004

Journal of Craniofacial Surgery

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Bicortical screw fixation after bilateral sagittal split osteotomy (BSSO) of the mandible is commonly used in orthognathic surgery and allows many advantages compared with osteosynthesis wires and maxillomandibular fixation. Complications include early loosening, hardware exposition, skeletal instability or early relapses, persistent nerve impairments, infection, and scar formation. This article is based on a retrospective analysis of complications of bicortical screw fixation observed in 241 consecutive patients with dento-skeletal Class III, corresponding to 482 sides, during the immediate postoperative period and at 1, 3, 6, and 12 months' follow-up. In the immediate postoperative period, poor stability of fixation caused by screw loosening was observed in 3 of 482 (0.62%) sides; at the 1-month follow-up, infections were encountered in 12 (2.48%) sides at mandibular angles. Additional complications were not seen in the series. Stability of fixation was found in the 482 sides at 12 months. However, complications directly related to bicortical screws were observed in 15 sides or 3.11%. Age and gender of patients were not correlated with the incidence of complications. Assiduous follow-up during the early postoperative period and 1 and 2 months after surgery is recommended in patients with bicortical screw fixation after BSSO to verify adequate oral hygiene and provide early observation of the onset of any infections, skeletal instabilities, or relapses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Complications of Bicortical Screw Fixation Observed in 482 Mandibular Sagittal Osteotomies

Becelli¹,

Fini²,

Renzi³

et al. 2004

Journal of Craniofacial Surgery

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“…Risk factors found to be associated with postoperative lingual nerve injury include young age, ASA PS I-II, and head-and-neck surgery. Numerous cases of postoperative tongue numbness, or lingual neuropraxy, have been reported in anesthesia-related [ 2 , 9 , 12 ] and surgery-related [ 13 , 14 ] journals. As a relatively rare postoperative complication, cases of postoperative lingual neuropraxy are mostly reported in the form of case reports or case series.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for postoperative lingual neuropraxia following airway instrumentation: A retrospective matched case-control study

Wang²,

Hsieh

et al. 2018

PLoS ONE

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BackgroundLingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway instrumentation during general anesthesia. This study explored the the incidence and perioperative risk factors for lingual nerve injury in patients receiving laryngeal mask (LMA) or endotracheal (ETGA) general anesthesia in a single center experience.Methods and resultsAll surgical patients in our hospital who received LMA or ETGA from 2009 to 2013 were included, and potential perioperative risk factors were compared. Matched controls were randomly selected (in 1:5 ratio) from the same database in non-case patients. A total of 36 patients in the records had reported experiencing tongue numbness after anesthesia in this study. Compared with the non-case surgical population (n = 54314), patients with tongue numbness were significantly younger (52.2±19.5 vs 42.0±14.5; P = 0.002) and reported lower ASA physical statuses (2.3±0.7 vs 1.6±0.6; P<0.001). Patient gender, anesthesia technique used, and airway device type (LMA or ETGA) did not differ significantly across the two groups. A significantly higher proportion of patients underwent operations of the head-and-neck region (38.9 vs 15.6%; P = 0.002) developed tongue numbness after anesthesia. Multivariate logistic regression analysis indicated that head-and-neck operations remained the most significant independent risk factor for postoperative lingual nerve injury (AOR 7.63; 95% CI 2.03–28.70).ConclusionThe overall incidence rate of postoperative lingual neuropraxy was 0.066% in patients receiving general anesthesia with airway device in place. Young and generally healthy patients receiving head-and-neck operation are at higher risk in developing postoperative lingual neuropraxy. Attention should be particularly exercised to reduce the pressure of endotracheal tube or laryngeal mask on the tongue during head-and-neck operation to avert the occurrence of postoperative lingual neuropraxy.

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“…1 Injury to sublingual soft tissues including the lingual nerve with postoperative numbness of the tongue is well reported. 2 However, to the best of our knowledge, the formation of postoperative sialocele due to iatrogenic injury to the Wharton’s duct in sublingual space has not been previously reported.…”

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confidence: 83%

Sialocele of Submandibular Gland, an Unreported Complication of Bilateral Sagittal Split Osteotomy

Dediol

Harmicar

Borumandi³

2022

Journal of Craniofacial Surgery

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Delayed presentation of SS is a unique problem for craniofacial surgeons. Children who present after 1 year of age are at greater risk of increased ICP and associated sequalae for a number of reasons. 7,12 Correction of SS in these patients is further complicated by decreased osteogenic potential and less malleability of the bone. 10 Delayed presentation has been corrected with both DO and CVR.Our variation on the described method of DO offers the potential advantages of an osteoplastic bone flap as the substrate for DO. This may mitigate the need to perform additional grafting procedures for bony defects. In addition, preservation of the origin of the temporalis muscle may decrease the risk of temporal hollowing. 13 Though this is a controversial topic, our method maintains the position of the temporalis muscle by preserving its attachments in situ. Maintaining the origin of the temporalis obviates the need to resuspend the muscle after dissection of the bone.In principle, DO effects a less thorough correction of scaphocephaly than CVR, as it addresses only the biparietal dimension and leaves forehead deformity untouched. In practice, however, CVR may fall short of its potential, healing with irregular contours and skull defects. In addition, CVR often requires blood transfusion due to high volume blood loss. Neither of the aforementioned patients required intraoperative transfusion. In older patients, benefits and risks must be weighed when determining which procedure to use. More comprehensive studies will need to be performed to evaluate the long-term outcomes in patients treated with DO using this variation, but in principle more vascularity often correlates with better bone healing. Described above is a relatively simple technique to preserve the vascularity of the temporalis muscle by preserving its origin and periosteal attachment to the parietal bones.

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Lingual nerve injury as a complication of rigid fixation of the sagittal ramus osteotomy: Report of a case

Cited by 20 publications

References 17 publications

Complications of Bicortical Screw Fixation Observed in 482 Mandibular Sagittal Osteotomies

Complications of Bicortical Screw Fixation Observed in 482 Mandibular Sagittal Osteotomies

Incidence and risk factors for postoperative lingual neuropraxia following airway instrumentation: A retrospective matched case-control study

Sialocele of Submandibular Gland, an Unreported Complication of Bilateral Sagittal Split Osteotomy

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