Karas N D, Boyd S B, Sinn D P
Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas.
J Oral Maxillofac Surg. 1990 Feb;48(2):124-34. doi: 10.1016/s0278-2391(10)80199-5.
The purpose of this study was to prospectively define the recovery of touch discrimination following four commonly performed surgical procedures in 22 consecutive patients with no previous maxillofacial surgery. The surgical groups studied were Le Fort I osteotomy (LEFORT; n = 13), sagittal split ramus osteotomy (SSRO; n = 6), intraoral vertical ramus osteotomy (IVRO; n = 9), and isolated genioplasty (GENIO; n = 5). Neurosensory function was assessed by three different testing modalities which included static light touch (SLT), moving touch discrimination (MTD), and two-point discrimination (TPD). Cutaneous sensation of the lower lip and chin were examined for the mandibular procedures, whereas the infraorbital and upper lip regions were evaluated following maxillary surgery. Immediately following surgery, each group varied in both the incidence and magnitude of neurosensory deficits (NSD). The SSRO group had the highest percentage of sites with immediate postsurgical NSD to both SLT (72%) and MTD (67%), followed by the LEFORT (SLT = 50%, MDT = 58%), GENIO (SLT = 27%, MTD = 6%), and IVRO groups (SLT = 11%, MTD = 18%), respectively. Each group also varied in the severity of the initial postoperative deficit as measured by SLT, with the SSRO group showing the greatest deficit followed by the LEFORT, GENIO, and IVRO groups. During the 6-month recovery period each group approached preoperative levels of sensation at a different rate. The LEFORT group recovered most rapidly, with few anatomic sites showing NSD (SLT = 20%, MTD = 5%) at the 1-month postoperative examination, and the majority of the group (96%) returned to preoperative sensation by 3 months following surgery. The SSRO group recovered more slowly, with approximately half of the group demonstrating a deficit (SLT = 50%, MTD = 59%) at 1 month, which diminished to about one fourth of the sites (SLT = 25%, MTD = 5%) by 3 months. Most of the SSRO group (90%) exhibited no residual deficit 6 months following surgery. The IVRO group had few sites with immediate NSD (SLT = 11%, MTD = 15%). In none of the surgical groups was a statistically significant correlation found between the severity of the initial NSD and length of time to complete recovery.
本研究的目的是前瞻性地确定22例既往无颌面外科手术史的连续患者在接受四种常见外科手术后触觉辨别能力的恢复情况。所研究的手术组包括Le Fort I型截骨术（LEFORT；n = 13）、下颌支矢状劈开截骨术（SSRO；n = 6）、口内下颌支垂直截骨术（IVRO；n = 9）和单纯颏成形术（GENIO；n = 5）。通过三种不同的测试方式评估神经感觉功能，包括静态轻触（SLT）、移动触觉辨别（MTD）和两点辨别（TPD）。对于下颌手术，检查下唇和颏部的皮肤感觉，而上颌手术后评估眶下和上唇区域。手术后即刻，每组神经感觉缺损（NSD）的发生率和严重程度各不相同。SSRO组术后即刻SLT和MTD出现NSD的部位百分比最高（分别为72%和67%），其次是LEFORT组（SLT = 50%，MDT = 58%）、GENIO组（SLT = 27%，MTD = 6%）和IVRO组（SLT = 11%，MTD = 18%）。根据SLT测量，每组术后初始缺损的严重程度也各不相同，SSRO组缺损最大，其次是LEFORT组、GENIO组和IVRO组。在6个月的恢复期内，每组感觉恢复到术前水平的速度不同。LEFORT组恢复最快，术后1个月很少有解剖部位出现NSD（SLT = 20%，MTD = 5%），术后3个月该组大多数患者（96%）恢复到术前感觉。SSRO组恢复较慢，1个月时约一半患者有缺损（SLT = 50%，MTD = 59%），3个月时缺损部位减少到约四分之一（SLT = 25%，MTD = 5%）。SSRO组大多数患者（90%）术后6个月无残留缺损。IVRO组术后即刻有NSD的部位很少（SLT = 11%，MTD = 15%）。在任何手术组中，均未发现初始NSD的严重程度与完全恢复所需时间之间存在统计学显著相关性。
