Assessment of Post-Operative Neurosensory Deficiency Following Le Fort I Maxillary Osteotomy and Its Impact on Patient Satisfaction: A Retrospective Clinical Cross-Sectional Study

Abstract

Background/Objectives: Le Fort I maxillary osteotomy (LF1-MO) is associated with a risk of infraorbital nerve neurosensory deficiency (NSD). This study aimed to evaluate post-operative subjective numbness and objective NSD after LF1-MO and assess the impact of these outcomes on overall patient satisfaction. Methods: A retrospective cross-sectional study was conducted among adult LF1-MO patients, who were evaluated for treatment satisfaction using a 10-item patient satisfaction questionnaire. In addition, subjective and objective NSDs were assessed post-operatively for six months. Overall patient satisfaction was compared against different variables (patient age, sex, and type of LF1-MO) and NSD. The proportion of subjective and objective NSDs were statistically correlated and compared against these variables, assuming a 95% significance level (p < 0.05). Results: A total of 58 LF1-MO patients in the age range of 20-38 years (mean-29.79 ± 4.62 years) were included in this study. Most patients were females (n = 48; 82.8%) and aged 30 years and older (n = 32; 55.2%). The overall mean patient satisfaction score was 27.38 ± 3.94 (range 12-30), which did not significantly differ based on patient age or sex. Patients who had advanced LF1-MO had significantly higher satisfaction scores (28.27 ± 1.85) compared to those who had impaction (24.61 ± 7.34) (p < 0.05). Subjective numbness and an abnormal "Level A" response to objective neurosensory testing were associated with poor patient satisfaction. There was significant statistical correlation between subjective and objective NSDs (Spearman's rho-0.441; p < 0.01). Based on a chi-squared test, patients undergoing maxillary setback (subjective-88.9%; objective-44.5%) had significantly higher NSDs (p < 0.05). Conclusions: Most patients reported satisfaction after LF1-MO, particularly among females, those aged 30 and older, and those without NSD. However, residual infraorbital NSDs persisted, with about two-thirds experiencing subjective numbness and 25% showing abnormal responses in "Level A" objective neurosensory tests six months post-operatively. Moreover, subjective numbness correlated with abnormal objective testing results, leading to lower patient satisfaction.

Keywords: Le Fort 1 osteotomy; maxillary osteotomy; neurosensory deficiency; orthognathic surgery; patient satisfaction.

Figure 1

Sensory and cutaneous innervation of the face by the maxillary and mandibular nerve and its branches. Black dotted transverse line in the maxillary bone indicate the representative Le Fort I osteotomy cut.

Figure 2

Objective testing for cutaneous neurosensory deficiency using the following stimuli: (a) pin-prick; (b) thermal (cold/heat); (c) static light-touch; (d) directional discrimination; and (e) two-point discrimination.