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Long-term neurosensory disturbances after modified sagittal split osteotomy.
O da Costa Senior1, B Gemels2, F Van der Cruyssen1
1University Hospitals Leuven, Campus Sint-Rafaël, Department of Oral and Maxillofacial Surgery, Kapucijnenvoer 33, 3000 Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Long-term neurosensory disturbances after modified bilateral sagittal split osteotomy affect 15% of patients. Older age, greater mandibular advancement, and nerve manipulation are key risk factors for altered sensation.
Area of Science:
- Oral and Maxillofacial Surgery
- Neurosurgery
- Orthognathic Surgery
Background:
- Modified bilateral sagittal split osteotomy (BSSO) is a common orthognathic procedure.
- Neurosensory disturbances are a known complication, but long-term incidence and risk factors require further investigation.
Purpose of the Study:
- To determine the long-term incidence of neurosensory disturbances following modified BSSO.
- To identify patient-specific and surgical factors associated with these disturbances.
Main Methods:
- Prospective study of 376 patients undergoing modified BSSO.
- Neurosensory disturbances evaluated at 6 months, and 1, 2, and 3 years postoperatively.
- Univariate and multivariate analyses assessed risk factors including age, sex, movement type, concurrent procedures, and graft use.
Main Results:
- 15% of patients reported altered sensation in the lower lip or chin at 3 years.
- Older age (p<0.0001), greater mandibular advancement (p=0.03), and intraoperative manipulation of the left inferior alveolar nerve (p=0.014) were significant risk factors.
- Older age, extensive advancement, and nerve manipulation correlated with long-term neurosensory disturbances.
Conclusions:
- The modified BSSO technique appears to minimize inferior alveolar nerve transection.
- Older patients and those requiring significant mandibular advancement are at higher risk for neurosensory disturbances.
- Careful surgical technique, particularly regarding nerve manipulation, is crucial for reducing long-term sensory complications.
