da Costa Senior O, Gemels B, Van der Cruyssen F, Agbaje J O, De Temmerman G, Shaheen E, Lambrichts I, Politis C
University Hospitals Leuven, Campus Sint-Rafaël, Department of Oral and Maxillofacial Surgery, Kapucijnenvoer 33, 3000 Leuven, Belgium; OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 33, 3000 Leuven, Belgium.
University Hospitals Leuven, Campus Sint-Rafaël, Department of Oral and Maxillofacial Surgery, Kapucijnenvoer 33, 3000 Leuven, Belgium.
Br J Oral Maxillofac Surg. 2020 Oct;58(8):986-991. doi: 10.1016/j.bjoms.2020.05.010. Epub 2020 Jul 4.
We have investigated the long-term incidence of neurosensory disturbances after modified bilateral sagittal split osteotomy, and identified associated risk factors. We prospectively studied 376 patients, and their self-reported neurosensory disturbances were evaluated six months, and one, two, and three years postoperatively. The correlations between the following risk factors and neurosensory disturbances were investigated using univariate analysis and stepwise multivariate analysis: age at operation, sex, type of movement (advancement, setback, or rotation), concurrent genioplasty, type of detachment, iliac crest bone graft, and use of dicalcium phosphate synthetic bone graft. Probabilities of less than 0.05 were accepted as significant. Three years postoperatively, 57 patients (15%) reported altered sensation of the lower lip or chin. Older age correlated significantly with neurosensory disturbances (p<0.0001). Greater mandibular advancement correlated with postoperative "positive" neurosensory phenomena (right side p=0.08; left side p=0.03). Intraoperative surgical manipulation of the left inferior alveolar nerve was significantly associated with postoperative hypoaesthesia (p=0.014). Older age at surgery, extensive mandibular advancement, and surgical manipulation of the left inferior alveolar nerve, were associated with long-term neurosensory disturbances after modified bilateral sagittal split osteotomy. The modified operation seems to safeguard the inferior alveolar nerve from transection, without causing damage to other nerves.
我们研究了改良双侧矢状劈开截骨术后神经感觉障碍的长期发生率，并确定了相关危险因素。我们对376例患者进行了前瞻性研究，在术后6个月、1年、2年和3年对他们自我报告的神经感觉障碍进行评估。使用单因素分析和逐步多因素分析研究以下危险因素与神经感觉障碍之间的相关性：手术年龄、性别、移动类型（前移、后退或旋转）、同期颏成形术、分离类型、髂嵴骨移植以及磷酸二钙合成骨移植的使用。概率小于0.05被认为具有统计学意义。术后3年，57例患者（15%）报告下唇或颏部感觉改变。年龄较大与神经感觉障碍显著相关（p<0.0001）。下颌前移幅度较大与术后“阳性”神经感觉现象相关（右侧p=0.08；左侧p=0.03）。术中对左下牙槽神经的手术操作与术后感觉减退显著相关（p=0.014）。手术时年龄较大、下颌广泛前移以及对左下牙槽神经的手术操作，与改良双侧矢状劈开截骨术后的长期神经感觉障碍相关。改良手术似乎可保护下牙槽神经不被横断，且不会对其他神经造成损伤。
