EFFECT OF MOVEMENT DIRECTION AND MAGNITUDE ON INFERIOR ALVEOLAR NERVE RECOVERY AFTER BILATERAL SAGITTAL SPLIT OSTEOTOMY: A 24-MONTH PROSPECTIVE COHORT STUDY
Nội dung chính của bài viết
Tóm tắt
Objective: To evaluate the effects of surgical movement direction (advancement vs. setback) and magnitude on inferior alveolar nerve (IAN) recovery following bilateral sagittal split osteotomy (BSSO) over 24 months.
Methods: A prospective cohort study enrolled 94 patients undergoing BSSO (47 advancements, 47 setbacks). IAN function was assessed at seven timepoints using the Visual Analog Scale (VAS) for subjective evaluation and the Zuniga classification for objective evaluation: Level A (two-point discrimination), Level B (static light touch), and Level C (pain/thermal thresholds). Statistical analyses included repeated-measures ANOVA (RM-ANOVA), Cochran's Q, and multivariate logistic regression.
Results: Neurosensory disturbance (NSD) peaked at one week (93.62% advancement; 95.74% setback). Level C fibers fully recovered by 12 months; Level A deficits persisted in 6.38% and 8.51% of patients at 24 months. Movement direction did not significantly affect NSD recovery (p > 0.05). Multivariate regression identified movement magnitude ≥5 mm (OR = 3.45; p = 0.01) and age ≥25 years (OR = 2.80; p = 0.03) as independent risk factors for persistent NSD at 6 months. VAS scores correlated strongly with Level A deficits (ρ = 0.79–0.90).
Conclusion: IAN recovery after BSSO is independent of movement direction but significantly delayed by older age and larger surgical movements. Level A sensory assessment (two-point discrimination) most accurately reflects patient-reported long-term paresthesia.
Chi tiết bài viết
Từ khóa
bilateral sagittal split osteotomy, inferior alveolar nerve, neurosensory disturbance, Zuniga classification.
Tài liệu tham khảo
[2] Agbaje JO, Salem AS, Lambrichts I, Jacobs R, Politis C. Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances. Int J Oral Maxillofac Surg. 2015;44(4):447-451. doi:10.1016/j.ijom.2014.11.010
[3] Mensink G, Gooris PJJ, Bergsma JE, van Hooft E, van Merkesteyn JPR. Influence of BSSO surgical technique on postoperative inferior alveolar nerve hypoesthesia: a systematic review of the literature. J Craniomaxillofac Surg. 2014;42(6):976-982. doi:10.1016/j.jcms.2014.01.019
[4] Yamauchi K, Takahashi T, Kaneuji T, Nogami S, Yamamoto N, Miyamoto I, et al. Risk factors for neurosensory disturbance after bilateral sagittal split osteotomy based on position of mandibular canal and morphology of mandibular angle. J Oral Maxillofac Surg. 2012;70(2):401-406. doi:10.1016/j.joms.2011.01.040
[5] Bruckmoser E, Bulla M, Alacamlioglu Y, Steiner I, Watzke IM. Factors influencing neurosensory disturbance after bilateral sagittal split osteotomy: retrospective analysis after 6 and 12 months. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;115(4):473-482. doi:10.1016/j.oooo.2012.08.454
[6] Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF. The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg. 1998;56(1):2-8. doi:10.1016/S0278-2391(98)90904-1
[7] Teerijoki-Oksa T, Jääskeläinen SK, Forssell K, Forssell H. Recovery of nerve injury after mandibular sagittal split osteotomy: diagnostic value of clinical and electrophysiologic tests in the follow-up. Int J Oral Maxillofac Surg. 2004;33(2):134-140. doi:10.1054/ijom.2003.0463
[8] Ylikontiola L, Kinnunen J, Oikarinen K. Factors affecting neurosensory disturbance after mandibular bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 2000;58(11):1234-1239. doi:10.1053/joms.2000.16621
[9] Li M, Li F, Zhu C, Li S, Zhang C, Le Y, et al. Impact of different lingual split patterns on inferior alveolar nerve recovery after bilateral sagittal split osteotomy in patients with skeletal class III malocclusion. J Craniomaxillofac Surg. 2025;53(8):1135-1140. doi:10.1016/j.jcms.2025.03.021
[10] Van Sickels JE, Hatch JP, Dolce C, Bays RA, Rugh JD. Effects of age, amount of advancement, and genioplasty on neurosensory disturbance after a bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 2002;60(9):1012-1017. doi:10.1053/joms.2002.34411