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. 2023 May-Jun;13(3):424-428.
doi: 10.1016/j.jobcr.2023.04.001. Epub 2023 Apr 28.

The inferior alveolar nerve at the proximal fragment during bilateral sagittal split osteotomy - Is there need to reposition to distal fragment?

Jingade Krishnojirao Dayashankara Rao  1
Affiliations

The inferior alveolar nerve at the proximal fragment during bilateral sagittal split osteotomy - Is there need to reposition to distal fragment?

Jingade Krishnojirao Dayashankara Rao. J Oral Biol Craniofac Res. 2023 May-Jun.

Erratum in

Abstract

Inferior alveolar nerve (IAN) injury is most common in bilateral sagittal split osteotomy (BSSO) cases. The present standard is to always reposition the IAN from the proximal fragment to the distal fragment during surgery. This study aims to assess the severity and incidence of postoperative injury and the recovery of the inferior alveolar nerve in proximal fragment entrapment.

Methods: - A total of 35 patients (70 BSSO osteotomies) with mandibular deformities requiring movements equal to or less than 6 mm were selected. Twenty out of 70 osteotomies had IAN on the proximal fragment (Group 1) while splitting. Group 2 included 20 osteotomies with IAN on the distal segment in the same patients. Therefore, 15 patients who had IAN on distal segments on both sides were excluded from this study. All the BSSO procedures were performed by the same surgeon. Postoperative recovery and follow-up were performed on the immediate 1st postoperative day and at 3-, 6- and 12-month intervals. The nociception (pin-prick discrimination) test and mechanoreceptive tactile skin test with cotton fibrils were performed by a third clinician who was blinded to the procedure to assess IAN sensation.

Conclusion: There was no significant difference between the groups in the recovery of IAN sensation after 6 months and the 1-year period. Hence reposition of IAN from the proximal segment to the distal segment during BSSO surgery may not be mandatory if the required movement is within 6 mm. This avoids unnecessary manipulation of the IAN over the proximal fragment.

Keywords: BSSO; BSSO complications; IAN recovery; Inferior alveolar nerve injury.

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Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
1- Inferior alveolar nerve entrapped in the proximal fragment after BSSO split.
Fig. 2
Fig. 2
Clinical picture showing Inferior Alveolar nerve entrapped in Proximal fragment.
Fig. 3
Fig. 3
Final Position stabilized with 4 hole Titanium Miniplate.
Fig. 4
Fig. 4
Final position of Inferior alveolar nerve and Mini plate after fixation of Bilateral sagittal split osteotomy.
Graph 1
Graph 1
Pin Prick test evaluation for sensation.
Graph 2
Graph 2
Tactile touch sensation test.
See this image and copyright information in PMC

References

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