Avoiding Inferior Alveolar Nerve Injury During Sagittal Split Ramus Osteotomy
Yoshitsugu Hattori1, Srinisha P Murali1, Lun-Jou Lo1,2
1Craniofacial Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.
Sagittal split ramus osteotomy (SSRO) can be safely performed even with the inferior alveolar nerve (IAN) positioned near the mandible's outer cortex. Preoperative imaging and direct visualization are key to preventing IAN injury during orthognathic surgery.
Area of Science:
- Oral and Maxillofacial Surgery
- Neurosurgery
- Anesthesiology
Background:
- Orthognathic surgery enhances facial aesthetics and occlusion.
- Sagittal split ramus osteotomy (SSRO) is a primary mandibular procedure in orthognathic surgery.
- Inferior alveolar nerve (IAN) injury is a frequent complication of SSRO.
Observation:
- A 19-year-old male with cleft lip and palate underwent orthognathic surgery with SSRO.
- The patient's right IAN was unusually close to the outer mandibular cortex.
- Computed tomography (CT) revealed the nerve's proximity before surgery.
Findings:
- SSRO was successfully completed without IAN injury.
- Detailed preoperative CT imaging is crucial for risk assessment.
- Direct intraoperative visualization within the ramus minimizes nerve damage risk.
Implications:
- SSRO is a viable orthognathic surgery option even with challenging IAN anatomy.
- Meticulous surgical technique, including nerve visualization, is essential for preventing complications.
- This case highlights the importance of advanced imaging and surgical precision in complex maxillofacial reconstructions.
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