Piezosurgery: A safe technique for inferior alveolar nerve mobilization in surgical correction of hemimandibular hyperplasia—Review of the literature and case report

Abstract

HighlightsHemimandibular hyperplasia is a developmental asymmetry characterized by three-dimensional enlargement of half of the mandible.Damage to the inferior alveolar nerve can be an adverse effect of surgical correction of hemimandibular hyperplasia.Precise bone cuts without damaging any soft tissue can be done by piezosurgery device.

Ultrasonic vs Drill Implant Site Preparation: Post-Operative Pain Measurement Through VAS, Swelling and Crestal Bone Remodeling: A Randomized Clinical Study

“…In this study model, each patient received only two dental fixtures in order to decrease the number of experimental variables. Furthermore, in the posterior mandible region the risk of damaging the alveolar nerve is greater [26], in fact, implant bed preparation with a piezoelectric device reduces the possible damage to the inferior alveolar nerves [27,28].…”

Methods of Definitive Correction of Mandibular Deformity in Hemimandibular Hyperplasia Based on Radiological, Anatomical, and Topographical Measurements—Proposition of Author’s Own Protocol

“…Condylar hyperplasia is related to one-sided abnormal pathological overgrowth of the mandible, related to a condyle head increase and prolonged growth in time [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Its etiology remains not fully known, while occurrence time, gender-related factors, growth components, and severity have been widely discussed in the known literature [ 1 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Olate et al’s and Nolte et al’s papers suggest more occurrence in the left condyle, with slight female predominance, while growth activity in time influences a later degree of mandibular asymmetry and also even secondary maxillary bite plane deviation [ 7 , 9 , 15 , 16 ].…”

“…Such cases have some characteristic features such as overgrowth of the mandible on the affected side, a descending and low-positioned mandibular canal with inferior alveolar nerve, a visible lack of bone symmetry, increased vertical ramus height, and enlargement of an entire one-sided mandibular body [ 26 , 27 , 28 , 29 ]. It is quite often the case that, in order to achieve a balanced profile, surgery involving inferior alveolar nerve (IAN) repositioning might be troublesome from a surgical point of view, and/or with patients who are unwilling to undergo any additional surgeries in close proximity to the neurovascular system because of the potential for injury of IAN [ 12 , 13 , 14 , 29 , 30 , 31 , 32 ]. In most cases, it is challenging to achieve excellent symmetry with a balanced profile or a level of symmetry that is close to the individual’s value.…”

“…A slight mandibular rotation toward the excised side minimizes the excess growth; however, this movement strongly coincides with the occurrence of a contra-lateral open bite, which enables it by reducing the gap between the glenoid fossa and the neo-head from the bony stump [ 5 , 6 , 7 , 8 ]. The following open bite and the degree of malocclusion influence the type of surgical approach, including the decision to proceed in stages (step-by-step procedure) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ] or with an all-in-one approach (one surgical approach) and rarely a surgery-first approach [ 7 , 8 , 9 , 10 , 22 , 23 , 24 ]. If the degree of an open bite is limited, and the condylar head is significantly enlarged in three dimensions, in some cases, a mandibular osteotomy should be combined with a condylectomy to improve the future neo-condyle position in the fossa and to decrease its instability and the probability of luxation [ 3 , 4 , 5 , 6 , 7 , 10 , 11 , 12 , 13 ].…”

“…Secondly, each mandibular bone overgrowth has its own individual volume but similar clinical and radiological features that are difficult to mislead from any other mandibular asymmetries [ 1 , 2 , 12 , 13 , 14 , 15 , 16 , 24 ]. In cases of severe overgrowths and troublesome asymmetries, the standard surgical protocol includes one of the used orthognathic surgery procedures [ 18 , 19 , 20 , 21 , 22 , 23 ].…”