Immediate Repair of Transected Inferior Alveolar Nerves in Sagittal Split Osteotomies

Abstract

Injury to the inferior alveolar nerve (IAN) in orthognathic surgery is a well-documented complication with the incidence of IAN transection in sagittal split osteotomies (SSOs) ranging from 1.3% to 7.0%. We describe our clinical experience with 3 cases of immediate microneural repair of IANs transected during SSO. Three cases of IAN transection (2 Sunderland degree V injuries, and 1 degree VI injury) that occurred during SSO were microsurgically repaired immediately by a trained microsurgeon. The other orthognathic surgery sites were positioned and fixed before the nerve repair commenced, and fixation of the nerve injury site was completed by the microsurgeon after nerve repair. All 3 patients were followed for at least 1 year with neurosensory testing, and showed recovery to mild or no sensory impairment. None had functional problems such as drooling, lip-biting, or speech difficulties at 1 year after surgery. Immediate nerve repair for transected IANs during SSO may be a feasible option, but requires the availability of a microsurgeon, instrumentation, and operating-room time.