Qualitative Descriptors Used by Patients Following Orthognathic Surgery to Portray Altered Sensation

Abstract

Following orthognathic surgery, patients use qualitatively different words to describe the altered sensation on their face that results from tissue inflammation and nerve injury. These words indicate normal, hypoesthetic, paresthetic, and dysesthetic sensations, and reflect the intrusiveness of the alteration. Our intent was to study the words chosen by patients from a standardized list to characterize sensory recovery during the first 6 months after surgery and to examine whether patients who underwent different surgical procedures tended to choose different sets of words. Patients' selections from a list of 27 words that described their assessment of spontaneous and evoked facial sensations were obtained before surgery and at 1 week, 1 month, 3 months, and 6 months after surgery. Data were obtained from 146 patients enrolled in a randomized controlled clinical trial designed to evaluate the potential of sensory retraining in the rehabilitation of patients who experience impairment in sensory function after nerve injury. Mantel Haenszel general correlation and row mean score statistics were used to assess the association between time and word choice and to compare the word choice categories of 4 surgical groups: bilateral sagittal split osteotomy (BSSO) only, with or without genioplasty; BSSO + Le Fort I, with or without genioplasty. In general, the number of words selected to describe the alteration in sensation decreased over time, as did the intrusiveness of the category of words chosen. However, the intrusiveness remained the same or worsened from 1 week to 6 months for 32% of patients. With increased time after surgery, the percentage of patients who reported altered evoked sensations exceeded the percentage who reported spontaneous sensations. For example, at 6 months the altered sensation of 66% of the patients was classified in the paresthesia and dysesthesia categories by the evoked assessment of sensation; whereas, that of only 47% of the patients were classified as such by the spontaneous assessment. The addition of Le Fort I to BSSO did not affect the way patients reported altered sensation on their lower face. Hypoesthesia and paresthesia, but not dysesthesia, were less of a problem on the midface than on the lower face after BSSO + Le Fort I. Patients who had genioplasty more frequently chose descriptors for the lower face that reflected soft tissue trauma and inflammation ("swollen," "tender," and "burning") than patients without genioplasty; however, this difference decreased with time after surgery. The current findings indicate that patients' selection of words differentiates individuals who experienced only a simple loss in sensation (ie, present negative symptoms), those who experienced active sensations that are not normally present (ie, present positive symptoms), and those whose active sensations are additionally uncomfortable or painful. It is possible that continued study of the latter group of patients will reveal patterns of word usage that predict poor long-term recovery and disabling sensory disorders.