Chortrakarnkij Peerasak, Lonic Daniel, Lin Hsiu-Hsia, Yamaguchi Kazuaki, Kim Sun-Goo, Lo Lun-Jou
From the *Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; †Division of Plastic Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand; ‡Craniofacial Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; and §Seran Plastic Surgery Clinic, Incheon, Korea.
Ann Plast Surg. 2017 Mar;78(3 Suppl 2):S108-S116. doi: 10.1097/SAP.0000000000001015.
Postoperative functional impairment of the inferior alveolar nerve (IAN) has been a common and well-recognized complication. Our study introduced a modified Obwegeser-Dal Pont bilateral sagittal split osteotomy (BSSO) technique and evaluated the subsequent incidence of postoperative neurosensory disturbance of IAN.
In this prospective cohort study, 57 patients receiving our modified BSSO during orthognathic surgery were enrolled. The technique contained opening the 2 ramus cortices and inserting the osteotome bypassing the IAN to avoid nerve injury. A 5-point scale self-assessment questionnaire was used to evaluate IAN neurosensory disturbance one week, six months and 12 months postoperatively. Differences between groups were analyzed using χ test for categorical and Wilcoxon signed-rank test for pairwise categorical data.
Complete ramus splitting could be achieved in 109 (95.6%) sides. Lower lip or chin neurosensory disturbances presented in 72 (63.2%) sides 1 week postoperatively and gradually reduced to 9 (7.9%), and 4 (3.5%) at postoperative months 6 and 12, respectively.
This BSSO technique could be safely performed with low rates of IAN exposure and injury and a low incidence of persistent neurosensory disturbance in 3.5% of patients 12 months postoperatively.
下牙槽神经（IAN）术后功能障碍一直是一种常见且广为人知的并发症。我们的研究引入了一种改良的Obwegeser-Dal Pont双侧矢状劈开截骨术（BSSO）技术，并评估了IAN术后神经感觉障碍的后续发生率。
在这项前瞻性队列研究中，纳入了57例在正颌手术期间接受我们改良BSSO的患者。该技术包括打开两个下颌支皮质，并插入骨凿绕过IAN以避免神经损伤。使用一份5分制的自我评估问卷在术后1周、6个月和12个月评估IAN神经感觉障碍情况。组间差异采用χ检验分析分类数据，采用Wilcoxon符号秩检验分析配对分类数据。
109侧（95.6%）可实现完全下颌支劈开。术后1周，72侧（63.2%）出现下唇或颏部神经感觉障碍，至术后6个月和12个月时分别逐渐降至9侧（7.9%）和4侧（3.5%）。
这种BSSO技术可以安全实施，IAN暴露和损伤率低，术后12个月时有3.5%的患者持续性神经感觉障碍发生率低。
