Evaluation of neurosensory disturbance following orthognathic surgery: a prospective study.

Abstract

The prospective study was to evaluate the incidence, type of neurosensory disturbance (NSD), grade its severity and monitor its recovery occurring in the lower lip and chin due to damage to inferior alveolar nerve following orthognathic surgery involving mandible. The study included 10 patients who have undergone sagittal split osteotomy, genioplasty, and anterior subapical osteotomy (ASO). All the patients examined preoperatively and post operatively 1week, 1 and 6months according to standardized test to clarify the subjective and objective neurosensory status of the injured nerve. Pin prick test, blunt test, two-point discrimator test, brush stoke direction, light touch test, warm and cold test were used bilaterally to lower lip and chin area. Seven patients underwent bilateral sagittal split osteotomy (BSSO) (70%), one patient had BSSO with genioplasty (10%), two patients had BSSO with ASO (20%). During the operation none of the nerves were transectioned, in 60% of patients nerve was not visible and in 40% of patients nerve was seen in distal segment. 70% of patients underwent setback, 30% of patients underwent advancement. The subjective evaluation of the patients revealed the incidence of 90% at 1week, 30% at 1month, 20% at 6months and 10% at 1year post operatively. The altered sensation reported subjectively was hypoesthesia in 50% of the patients, anaesthesia in 40% of the patients. There was 100% recovery in advancement cases and 93.5% recovery in setback cases. There is a high incidence of NSD of the lower lip and chin after BSSO related to advancement, setback, intraoperative nerve encounter and surgical skill. However, recovery of sensation occurs with increasing frequency during the follow-up period. The clinical neurosensory tests are effective guides to study the neurosensory deficit.