Kobayashi Akiko, Yoshimasu Hidemi, Kobayashi Jyunji, Amagasa Teruo
Maxillofacial Surgery, Maxillofacial Reconstruction and Function, Division of Maxillofacial and Neck Reconstruction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
J Oral Maxillofac Surg. 2006 May;64(5):778-84. doi: 10.1016/j.joms.2006.01.009.
This study investigated neurosensory disturbances in patients after orthognathic surgery in relation to differences in mandibular splitting methods and degree of surgical skill.
Forty-five patients who had undergone bilateral sagittal split ramus osteotomies (SSRO), and 21 (group L) who had undergone intraoral inverted L ramus osteotomies (ILRO), were examined for postsurgical neurosensory disturbances. Twenty-two (group S1) of the SSRO patients were treated by 11 surgeons who had little experience, and the others (23 patients; group S2) were treated by 2 skilled surgeons who had considerable experience. One of the 2 skilled surgeons was the only surgeon carrying out the ILRO procedure. The neurosensory tests employed included light touching using a Semmes-Weinstein monofilament tester (SW tester), electrical stimulation, and a questionnaire to determine changes in subjective sensations, at the time of each sensory evaluation. Neurosensory examinations were carried out bilaterally (132 sides) at 1, 3, 6, and 12 months after surgery.
More patients showed abnormal thresholds for the 2 measurement techniques in the SSRO group than in the ILRO group, and furthermore there were more such patients in group S1 than in group S2, at each measurement point. At 6 months after surgery, the number of patients with reduced sensitivity was significantly higher in group S1 than in group L (P < .05). In the SSRO group at each measurement point, the thresholds for the lower lip and chin were unrelated to the set-back (or advance) distance. By contrast, in group L only at the 1-month evaluation point, the thresholds for the lower lip and chin were significantly raised in patients whose setback distances were larger than average (P < .05).
Postsurgical neurosensory disturbances of the lower lip and chin occur more frequently in SSRO patients treated by surgeons having little experience than in those treated by skilled surgeons, although the difference is not significant. Long-term prognosis for resolution of postsurgical neurosensory disturbances is better in ILRO patients than in SSRO patients. Although the width of movement of the split bone fragments has an influence on postsurgical neurosensory disturbances immediately after ILRO, the relationship becomes less obvious with time.
本研究调查正颌外科手术后患者的神经感觉障碍情况，及其与下颌骨劈开方法差异和手术技巧程度的关系。
对45例行双侧矢状劈开下颌支截骨术（SSRO）的患者以及21例行口内倒L形下颌支截骨术（ILRO）的患者（L组）进行术后神经感觉障碍检查。SSRO组中的22例患者（S1组）由11名经验不足的外科医生治疗，其余23例患者（S2组）由2名经验丰富的熟练外科医生治疗。2名熟练外科医生中的1名是唯一实施ILRO手术的医生。每次感觉评估时，采用的神经感觉测试包括使用Semmes-Weinstein单丝测试仪（SW测试仪）进行轻触、电刺激以及一份用于确定主观感觉变化的问卷。在术后1、3、6和12个月对双侧（共132侧）进行神经感觉检查。
在每个测量点，SSRO组中显示两种测量技术阈值异常的患者比ILRO组更多，而且S1组中此类患者比S2组更多。术后6个月，S1组中感觉减退的患者数量显著高于L组（P < 0.05）。在SSRO组的每个测量点，下唇和下巴的阈值与后退（或前移）距离无关。相比之下，仅在L组的1个月评估点，后退距离大于平均值的患者下唇和下巴的阈值显著升高（P < 0.05）。
经验不足的外科医生治疗的SSRO患者下唇和下巴术后神经感觉障碍的发生率高于经验丰富的外科医生治疗的患者，尽管差异不显著。ILRO患者术后神经感觉障碍恢复的长期预后优于SSRO患者。虽然ILRO术后劈开骨块的移动宽度对术后即刻的神经感觉障碍有影响，但随着时间推移这种关系变得不那么明显。
