Kokuryo Shinya, Habu Manabu, Kita Ryosuke, Katsuki Takeshi, Tominaga Kazuhiro, Yoshioka Izumi
Assistant Professor, Division of Oral Medicine, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan.
Assistant Professor, Division of Oral and Maxillofacial Surgery, Department of Physical Functions, Kyushu Dental University, Kitakyushu, Japan.
J Oral Maxillofac Surg. 2018 Jul;76(7):1539-1545. doi: 10.1016/j.joms.2017.12.023. Epub 2018 Jan 3.
According to the literature, ultrasonic surgery reduces the incidence of neurosensory disturbance (NSD) of the inferior alveolar nerve (IFAN) after bilateral sagittal split osteotomy (BSSO). The purpose of this study was to evaluate the effects of ultrasonic surgery and the anatomic position of the IFAN canal on NSD after BSSO.
This retrospective cohort study included skeletal mandibular prognathism cases operated on with an ultrasonic bone scalpel or a reciprocating saw. The primary predictor variable was osteotomy technique (ultrasonic or conventional surgery). The primary outcome variable was NSD. Other variables included age, gender, operator, degree of setback, surgical duration, blood loss, and IFAN position. Comparisons of 2 variables were performed by use of the Student t test or Fisher exact test. A regression model was used to examine the relationship between the presence or absence of NSD and other variables. The level of significance was set at P < .05 for all statistical tests.
The ultrasonic group was composed of 35 patients, whereas the conventional group was composed of 32. Three months after surgery, NSD was observed on 16 of 70 sides (22.9%) in the ultrasonic group and 28 of 64 sides (43.8%) in the conventional group; this difference was significant. Furthermore, recovery from NSD at 3 months after BSSO was significantly more common in the ultrasonic group than in the conventional group. In the ultrasonic group, even when the distance from the buccal aspect of the IFAN canal to the outer buccal cortical margin was shorter, NSD of the IFAN was less frequent.
Ultrasonic surgery may be an effective technique to reduce the incidence of NSD after BSSO, and it contributed to recovery from NSD. The use of an ultrasonic device for BSSO is recommended when the distance from the buccal aspect of the IFAN canal to the outer buccal cortical margin is shorter on computed tomography.
根据文献报道，超声手术可降低双侧矢状劈开截骨术（BSSO）后下牙槽神经（IFAN）神经感觉障碍（NSD）的发生率。本研究旨在评估超声手术以及IFAN管的解剖位置对BSSO后NSD的影响。
本回顾性队列研究纳入了使用超声骨刀或往复锯进行手术的下颌骨前突病例。主要预测变量为截骨技术（超声或传统手术）。主要结局变量为NSD。其他变量包括年龄、性别、手术医生、后退程度、手术时长、失血量以及IFAN位置。使用Student t检验或Fisher精确检验对两个变量进行比较。采用回归模型检验NSD的有无与其他变量之间的关系。所有统计检验的显著性水平设定为P < 0.05。
超声组有35例患者，传统组有32例。术后3个月，超声组70侧中有16侧（22.9%）出现NSD，传统组64侧中有28侧（43.8%）出现NSD；差异具有显著性。此外，BSSO术后3个月时，超声组NSD恢复的情况明显比传统组更常见。在超声组中，即使IFAN管颊侧至颊侧皮质骨外缘的距离较短，IFAN发生NSD的频率也较低。
超声手术可能是一种有效降低BSSO后NSD发生率的技术，且有助于NSD的恢复。当计算机断层扫描显示IFAN管颊侧至颊侧皮质骨外缘的距离较短时，建议在BSSO中使用超声设备。
