Discussion

Abstract

Although the advantages of rigid over wire fixation for patients with mandibular advancement are widely recognized, the severity of inferior alveolar nerve damage has been particularly difficult to compare. In contrast to other standardized outcome measures (eg, cephalometric analyses), there is little consensus as to which tests of neurosensory function should be used, how the tests should be administered, or how the results should be interpreted and reported. As such, comparison of published clinical studies in which either rigid or wire fixation was employed has provided conflicting information. Similarly, comparison of clinical data retrospectively at the same institution has been problematic because of the “selective and subjective” nature of neurosensory information in patient records. 1 Buckley MJ Tulloch JFC White RP et al. Complications of orthognathic surgery: A comparison between wire fixation and rigid internal fixation. Int J Adult Orthod Orthognath Surg. 1989; 4: 69 PubMed Google Scholar Given these considerations, multicenter, randomized clinical trials are crucial to the identification of differences in neurosensory complications and their clinical implications. Although such studies were in progress 10 years ago, 2 Hatch JP Rugh JD Bays RA et al. Psychological function in orthognathic surgical patients before and after bilateral sagittal split osteotomy with rigid and wire fixation. Am J Orthod Dentofacial Orthop. 1999; 115: 536 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar this report by Lemke et al is the first to address specifically whether rigid fixation results in greater neurosensory impairment than does wire fixation. The analyses provide valuable insight, but 2 concerns remain largely unresolved. First, the 2 tests of neurosensory function (light touch detection and brush stroke direction) were found to provide different results statistically. Second, the implications of the difference in the thresholds for brush stroke direction are unclear with regard to the risk for, and the severity of, neurosensory impairment after rigid versus wire fixation.