Management of inferior alveolar nerve dysfunction associated with orthognathic surgery

Abstract

The relationship between inferior alveolar nerve (IAN) injury and orthognathic surgery of the mandible is ubiquitous. Both the patient and the surgeon generally expect nerve injury. The results of nerve injury can be sensory impairment involving the anatomic distributions of the injured nerve. This impairment can be temporary or permanent, nonpainful or painful, mild, moderate, severe, or complete.The management of IAN dysfunction following orthognathic surgery includes the provision of a diagnosis, prognosis and treatment options. The management is applied to preoperative, intraoperative, and postoperative events.Preoperative management involves understanding the risks of nerve injury in specific conditions and providing adequate informed consent. Intraoperative management depends on whether the IAN injury was a witnessed or unwitnessed injury and whether the witnessed injury was avulsive. Rarely are microsurgical techniques applied to correct IAN injuries during orthognathic surgery. Postoperative management depends upon whether the IAN injury was witnessed or unwitnessed. In the unwitnessed condition the recommendation includes physical examination and neurosensory testing until definitive diagnosis and prognosis of the injury can be provided so that treatment can be based on evidence based clinical findings. Rarely is microneurosurgery indicated, and when surgery is performed it is generally performed for the management of a painful dysesthesia.There may be better treatment options for IAN injury associated with orthognathic surgery in the future. These options may include sensory re-education, neurotropic/neurotrophic drug therapy, time-dependent steroid therapy or neuroprotective surgery.ReferencesZuniga JR, Chen N: OMS Knowledge Update 1, part 11, 1995Panula K, Finne K, Oikarinen K: J Oral Maxillofac Surg 59:1128, 2001Essick G, Austin S, Phillips C, et al: Oral Maxillofac Surg Clin North Am 13:295, 2001 The relationship between inferior alveolar nerve (IAN) injury and orthognathic surgery of the mandible is ubiquitous. Both the patient and the surgeon generally expect nerve injury. The results of nerve injury can be sensory impairment involving the anatomic distributions of the injured nerve. This impairment can be temporary or permanent, nonpainful or painful, mild, moderate, severe, or complete. The management of IAN dysfunction following orthognathic surgery includes the provision of a diagnosis, prognosis and treatment options. The management is applied to preoperative, intraoperative, and postoperative events. Preoperative management involves understanding the risks of nerve injury in specific conditions and providing adequate informed consent. Intraoperative management depends on whether the IAN injury was a witnessed or unwitnessed injury and whether the witnessed injury was avulsive. Rarely are microsurgical techniques applied to correct IAN injuries during orthognathic surgery. Postoperative management depends upon whether the IAN injury was witnessed or unwitnessed. In the unwitnessed condition the recommendation includes physical examination and neurosensory testing until definitive diagnosis and prognosis of the injury can be provided so that treatment can be based on evidence based clinical findings. Rarely is microneurosurgery indicated, and when surgery is performed it is generally performed for the management of a painful dysesthesia. There may be better treatment options for IAN injury associated with orthognathic surgery in the future. These options may include sensory re-education, neurotropic/neurotrophic drug therapy, time-dependent steroid therapy or neuroprotective surgery. References Zuniga JR, Chen N: OMS Knowledge Update 1, part 11, 1995 Panula K, Finne K, Oikarinen K: J Oral Maxillofac Surg 59:1128, 2001 Essick G, Austin S, Phillips C, et al: Oral Maxillofac Surg Clin North Am 13:295, 2001