Department of Orthodontics, The Royal London Hospital, London, United Kingdom.
Department of Oral and Maxillofacial Surgery, The Royal London Hospital, London, United Kingdom.
Am J Orthod Dentofacial Orthop. 2021 Sep;160(3):410-422. doi: 10.1016/j.ajodo.2020.11.038. Epub 2021 May 8.
This study aimed to investigate the incidence and recovery of neurosensory deficit (NSD) after LeFort I osteotomy over 12 months and identify any association between age, gender, and extent of surgical movement on recovery. Furthermore, the study explored the relationship between objective and subjective outcome measures.
A prospective cohort study consisting of 31 patients. Subjects were assessed at baseline, 1 week (T1), 1 month, 3 months, 6 months, and 12 months (T5) after LeFort I osteotomy. Objective assessment measures included pinprick (PP), static light touch (SLT), static 2-point discrimination (STPD), and electric pulp testing (EPT). Subjective reporting was undertaken using a visual analog scale. Patients rated the impact of NSD on intraoral and extraoral sites at the same time points as for objective measures.
Twenty-eight patients (16 females and 12 males) with a mean age of 24.5 years (standard deviation, 7.4) completed the study. There was a notable reduction in NSD from T1 (85.7%) to T5 (17.9%). No significant differences were found with respect to the influence of gender; PP (P = 0.06), SLT (P = 0.10), STPD (P = 0.65) and EPT (P = 0.19) or extent of surgical movement; PP (P = 0.50), SLT (P = 0.72), STPD (P = 0.06) and EPT (P = 0.74) on NSD. Age is a significant factor for intraoral NSD in the immediate postoperative period; PP (P < 0.0001) and SLT (P < 0.0001). Subjectively, patients reported a high degree of concern associated with NSD immediately after surgery with a gradual reduction from T1 to T5. There is a significant difference in subjective reporting between those with intraoral NSD than those with no intraoral NSD at 12 months (P = 0.031).
NSD is high after LeFort I surgery, particularly intraorally in the palate. At 12 months, the incidence of NSD is 17.9%. Recovery of NSD to a nonsignificant value from baseline takes up to 3 months for extraoral sites and between 3 and 6 months for intraoral soft tissues. The maxillary dentition continues to recover from NSD up to 12 months postsurgery. Age, gender, and extent of the surgical movement do not influence the extent of NSD at 12 months. Increasing age is associated with increased NSD at intraoral sites immediately after surgery. Intraoral NSD is more of a concern to patients than extraoral NSD. Patients' concerns associated with NSD reduced over time, demonstrating a degree of adaptation in the longer term.
本研究旨在探讨 12 个月内 LeFort I 截骨术后神经感觉缺失（NSD）的发生率和恢复情况，并确定年龄、性别和手术移动范围与恢复之间的任何关联。此外，本研究还探讨了客观和主观结果测量之间的关系。
一项由 31 名患者组成的前瞻性队列研究。受试者在 LeFort I 截骨术后基线、1 周（T1）、1 个月、3 个月、6 个月和 12 个月（T5）进行评估。客观评估测量包括刺痛（PP）、静态轻触（SLT）、静态 2 点辨别（STPD）和电牙髓测试（EPT）。主观报告采用视觉模拟量表进行。患者在与客观测量相同的时间点对内口和外口的 NSD 影响进行评分。
28 名患者（16 名女性和 12 名男性）完成了研究，平均年龄为 24.5 岁（标准差，7.4）。从 T1（85.7%）到 T5（17.9%），NSD 显著减少。性别对 PP（P=0.06）、SLT（P=0.10）、STPD（P=0.65）和 EPT（P=0.19）或手术移动范围无显著影响；PP（P=0.50）、SLT（P=0.72）、STPD（P=0.06）和 EPT（P=0.74）对 NSD 无影响。年龄是术后即刻内口 NSD 的一个重要因素；PP（P<0.0001）和 SLT（P<0.0001）。主观上，患者在手术后立即报告了与 NSD 相关的高度关注，并从 T1 到 T5 逐渐减少。12 个月时，有 NSD 的患者与无 NSD 的患者之间的主观报告存在显著差异（P=0.031）。
LeFort I 手术后 NSD 发生率较高，尤其是在上腭的内口。12 个月时，NSD 的发生率为 17.9%。NSD 从基线恢复到无显著性意义需要 3 个月才能达到外口，而内口软组织需要 3 至 6 个月。上颌牙齿的 NSD 持续到术后 12 个月。年龄、性别和手术移动范围在 12 个月时不影响 NSD 的程度。年龄越大，术后即刻内口 NSD 发生率越高。内口 NSD 比外口 NSD 更让患者担心。随着时间的推移，患者与 NSD 相关的担忧减少，表明在较长时间内有一定程度的适应。
