English

Abstract

Introduction The aim of the present study was to highlight the incidence and patients’ subjective perception of neurosensory disturbance and the degree of satisfaction after bilateral sagittal split osteotomies, at least 3 years after surgery. Materials and Methods The sample population consisted of all 52 consecutively operated subjects who had undergone bilateral sagittal split osteotomies between the years 2003 and 2008 at the Department of Maxillofacial Surgery at Orebro University Hospital. Patients were contacted by a letter and asked to complete a questionnaire about perceived sensory changes after the operation and their satisfaction with the result of the operation. Discussion The lack of standard methods for evaluating neurosensory disturbance is evident. Thus, the evaluation methods in the literature vary from strictly subjective to strictly objective. However, the most important factor, from the patient’s point of view, must be the patient’s own perception of the nerve impairment, not what the objective results indicate. Conclusion Half of the operated subjects had longlasting neurosensory disturbance. However, the majority of the patients (89%) were satisfied with the result of the operation despite sensory disturbances of some degree. It appears that neurosensory disturbance is not the main determining factor of patient satisfaction and seems outbalanced by preoperative information and results of function and aesthetics. Introduction The bilateral sagittal split osteotomy (BSSO), described as early as in 19571, is the most frequently used procedure to correct mandibular skeletal discrepancies by lengthening or shortening the mandible. Neurosensory disturbances (NSDs) of the lower lip and chin following this procedure are commonly due to lesions of the inferior alveolar nerve and its terminal branch, the mental nerve. This can be caused by surgical oedema, stretching, pressure, the split itself and the possible compression of the nerve during fixation2,3. The symptoms of a nerve lesion are usually varying degrees of numbness of the lower lip and chin4. Although the nerve impairment is of purely sensory nature, and consequently no motor deficit occurs, the problem concerns the patient, as anyone who has had an inferior alveolar nerve block for dental anaesthesia can well understand. This sensory deficit is not only an unpleasant sensation, but may also affect the patient’s ability to talk and masticate efficiently without traumatising the involved area2. There are many published studies of NSD in patients undergoing orthognathic surgery, but there are few studies evaluating the patients’ own perception, which could differ from the surgeon’s judgement, and often is underestimated by clinicians when compared to the patients’ subjective symptoms5,6. Most studies on the outcome of sensory function after BSSO have used the final follow-up for evaluation (2–2.5 years)3. The aim of the present study was to descriptively highlight the incidence and patients’ subjective perception of sensory impairment in the lower lip and chin and the degree of satisfaction after mandibular orthognathic surgery with BSSO at least 3 years after surgery. Materials and Methods The study protocol was approved by the Regional Ethical Review Board in Uppsala, Sweden, which follows the guidelines of the Declaration of Helsinki. All the patients (n = 52; 23 men and 29 women) who had an up-to-date address and had undergone BSSO, between the years 2003 and 2008, at the Department for Maxillofacial Surgery at Orebro University Hospital, Orebro, were contacted by a letter and were asked to participate in this study. The records of these patients were reviewed at the Department of Orthodontics in Orebro County. Subjects with craniofacial syndromes, facial trauma, pre-existing NSD and out-of-date home addresses were not considered eligible for the study. Seven subjects fulfilled the exclusion criteria. The youngest patient in this study was 21 years old. The observation period between the years 2003 and 2008 indicates a follow-up from 3 up to 8 years post-operation in this study. The operation technique used for BSSO at the Department for Maxillofacial Surgery was standardised, * Corresponding author Email: farhan.bazargani@orebroll.se 1 Public Dental Clinic, Folktandvarden Drottninggatan, Helsingborg, Sweden 2 Postgraduate Dental Education Center, Orebro, Sweden 3 Department of Social Dentistry, Faculty of Odontology, Malmo University, Malmo, Sweden 4 Department of Orthodontics, Postgraduate Dental Education Center, P.O. Box 1126, SE-701 11, Orebro, Sweden