Secondary Inferior Alveolar Nerve Repair During Revisional Orthognathic Surgery

Revisional orthognathic procedures are increasingly requested by patients who remain dissatisfied with facial aesthetics after primary correction of dentofacial deformities. Neurosensory disturbance of the inferior alveolar nerve (IAN) is a well-recognized complication of sagittal split ramus osteotomy (SSRO), and inadvertent IAN transection can result in severe permanent neurosensory deficits if not properly repaired. The authors report a 41-year-old woman who presented with persistent "prognathic appearance" and left lower lip hypesthesia 7 years after mandibular setback surgery using bilateral SSRO. Preoperative computed tomography revealed discontinuity of the left IAN, consistent with an untreated transection from the previous operation. Revisional orthognathic surgery with clockwise rotation of the maxillomandibular complex was performed, and simultaneous secondary repair of the IAN was achieved. Postoperatively, both facial profile and neurosensory function had improved, with high patient satisfaction. Secondary IAN repair at the time of revisional orthognathic surgery may promote sensory recovery and favorable functional and aesthetic outcomes.