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Risk factors of nerve injury during mandibular sagittal split osteotomy
T Teerijoki-Oksa1, S K Jääskeläinen, K Forssell
1Department of Oral and Maxillofacial Surgery, Turku University Central Hospital, Finland. tuija.teerijoki-oksa@fimnet.fi
International Journal of Oral and Maxillofacial Surgery
|April 9, 2002
Summary
Bilateral sagittal split osteotomy (BSSO) can injure the inferior alveolar nerve (IAN). Longer surgical times and specific mandibular anatomy increase this risk, highlighting the need for careful surgical technique to prevent IAN damage.
Area of Science:
- Oral and Maxillofacial Surgery
- Neurophysiology
- Anatomy
Background:
- Inferior alveolar nerve (IAN) injury is a known complication of bilateral sagittal split osteotomy (BSSO).
- Objective data correlating surgical technique and mandibular anatomy with IAN injury risk during BSSO is limited.
Purpose of the Study:
- To objectively assess the impact of surgical technique and patient-specific mandibular anatomy on inferior alveolar nerve (IAN) function during bilateral sagittal split osteotomy (BSSO).
- To identify specific surgical maneuvers and anatomical variations that increase the risk of IAN injury.
Main Methods:
- Continuous recording of orthodromic sensory nerve action potentials (SNAPs) from the IAN in 20 patients undergoing BSSO.
- Analysis of changes in SNAP latency, amplitude, and sensory nerve conduction velocity (SNCV) throughout the surgical procedure.
- Correlation of electrophysiological nerve changes with surgical duration, specific surgical steps, and pre-operative anatomical measurements (corpus height, mandibular canal location).
Main Results:
- Significant alterations in IAN electrophysiology (prolonged latency, diminished amplitude, slowed SNCV) were observed during BSSO (P < 0.0001 for all).
- The most pronounced nerve conduction changes occurred during medial ramus procedures, with longer durations correlating with greater IAN disturbance (R = -0.529 to -0.605).
- Low mandibular corpus height (R = 0.802) and a mandibular canal positioned near the inferior border (R = 0.52) were associated with increased IAN injury risk.
Conclusions:
- Surgical duration and specific anatomical factors, including low corpus height and mandibular canal proximity to the inferior border, are significant risk factors for IAN injury during BSSO.
- While direct nerve exposure may not always cause injury, nerve laceration increases the risk of functional disturbance.
- Electrophysiological monitoring provides objective data on IAN status during BSSO, aiding in risk assessment and surgical decision-making.