Gennaro Paolo, Giovannoni Maria Elisa, Pini Niccolò, Aboh Ikenna Valentine, Gabriele Guido, Iannetti Giorgio, Cascino Flavia
Department of Oral and Maxillofacial Surgery, University of Siena, Firenze, Italy.
J Craniofac Surg. 2017 Jul;28(5):1375-1379. doi: 10.1097/SCS.0000000000003606.
The purpose of this study was to evaluate how different exposures of the V3 nerves during orthognathic surgery impact neurosensory disturbances.
The study included 127 patients who underwent either bilateral sagittal split osteotomy (BSSO) or BSSO with maxillary le Fort 1. They were divided into 6 groups, identified by the quantity of V3 nerve exposure. All patients were examined in a pre-op period and again after 1, 3, 6 months post-op. The standardized tests used were to clarify the objective and subjective neurosensory status of the exposed nerve. Neurosensory evaluation included; a pin prick test, the 2 points discriminator, light touch, warm and cold tests, and blunt discrimination. They were all done bilaterally on the lower lip area.
In only 2 patients the nerve was damaged during surgery and thus they were not included in this study. In 10.2% of patients there was no nerve exposure, 25.2% had longitudinal vestibular segment nerve exposed, 22.8% had the longitudinal upper-vestibular segment exposed, 20.5% had the longitudinal lower-vestibular segment exposed, 14.2% had the longitudinal upper-lower-vestibular segment exposed, and in 7.1% of patients the nerve was totally exposed. Given the estimated time of 1 month there was 100% recovery in patients whose nerve was unexposed. Considering the other patients, the authors had a variable number of patients who did not recover completely.
The authors estimate a correlation between the recovery time and the quantity of the exposed nerve. There is a high incidence of neurosensory disturbance in the lower lip and chin after BSSO and intraoperative quantity of nerve exposure.
本研究旨在评估正颌手术中V3神经的不同暴露程度如何影响神经感觉障碍。
该研究纳入了127例行双侧矢状劈开截骨术（BSSO）或BSSO联合上颌Le Fort 1截骨术的患者。他们被分为6组，根据V3神经暴露量进行识别。所有患者在术前及术后1、3、6个月接受检查。所使用的标准化测试旨在明确暴露神经的客观和主观神经感觉状态。神经感觉评估包括：针刺试验、两点辨别试验、轻触觉、温觉和冷觉试验以及钝性辨别试验。所有这些试验均在双侧下唇区域进行。
仅2例患者在手术过程中神经受损，因此未纳入本研究。10.2%的患者未暴露神经，25.2%的患者纵向前庭段神经暴露，22.8%的患者纵向上前庭段暴露，20.5%的患者纵向前庭下段暴露，14.2%的患者纵向上下前庭段暴露，7.1%的患者神经完全暴露。预计1个月时间，未暴露神经的患者100%恢复。考虑其他患者，作者发现有不同数量的患者未完全恢复。
作者估计恢复时间与暴露神经的量之间存在相关性。BSSO术后下唇和下巴神经感觉障碍的发生率较高，且与术中神经暴露量有关。
