Does the Low and Short Medial Cut Affect Lingual Nerve Recovery after Sagittal Split Osteotomy?
Philip D Tolley1, Benjamin B Massenburg1, Julia Higgins1
1From the Craniofacial Center, Division of Oral and Maxillofacial Surgery, and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital; and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington.
Background:
The purpose of this study was to evaluate the recovery of lingual nerve (LN) neurosensory function in patients undergoing sagittal split osteotomy (SSO) with a low and short medial horizontal cut.
Methods:
This was a prospective study of patients with mandibular deformities undergoing SSO with a low and short medial horizontal cut over a 4-year period. The outcomes of interest were neurosensory recovery of the LN, as assessed objectively using functional sensory recovery (FSR) and subjectively by patient report.
Results:
The sample included 123 SSOs in 62 subjects with a mean age of 19.3 ± 3.1 years. Thirty-seven subjects (61.7%) were female. Mandibular advancements were performed in 52 SSOs (42.3%); mandibular setbacks were performed in 71 SSOs (57.7%). One subject underwent revision BSSO. FSR was achieved at 122 LNs (99.1%) within 6 weeks postoperatively, with 120 sites (97.5%) having S4 sensation at 6 weeks. Decreased LN sensation was reported at 10 (8.3%) sites at 1 week postoperatively. At 6 weeks postoperatively, 118 sites (97.5%) had reported normal sensation. By 12 weeks postoperatively, all LN sites had S4 sensation and there were no subjective complaints. Revision sagittal split osteotomy was associated with prolonged (≥6 weeks) time to S4 sensation ( P = 0.02) and subjective complaint of decreased sensation ( P = 0.02).
Conclusions:
LN sensory recovery occurs rapidly following the low and short SSO, with 99% of sites achieving FSR and subjectively normal sensation within 6 weeks of surgery and all patients achieving FSR with S4 sensation by 12 weeks postoperatively. LN sensory recovery may be prolonged in patients undergoing revision SSO.
Clinical Question/Level Of Evidence:
Therapeutic, IV.
