Schlund Matthias, Grall Patrick, Ferri Joël, Nicot Romain
Univ. Bordeaux, CHU Bordeaux, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, BioTis - Bioengineering of Tissues Inserm U1026, F-33000 Bordeaux, France.
Univ. Lille, CHU Lille, Service de Chirurgie Maxillo-Faciale et Stomatologie, F-59000 Lille, France.
Br J Oral Maxillofac Surg. 2022 Oct;60(8):1086-1091. doi: 10.1016/j.bjoms.2022.04.001. Epub 2022 Apr 13.
The aim of this study was to assess the occurrence of neurosensory disturbance of the inferior alveolar nerve (IAN) following modified mandibular bilateral sagittal split osteotomy (BSSO) that preserves the mandibular inferior border. All patients undergoing BSSO, associated or not with a Le Fort I osteotomy (performed by the same senior operator) between January 2018 and December 2019, were eligible. The modified BSSO consists of a modification of the technique described by Epker: the bony section of the buccal cortex stops 3-4 mm above the basal mandibular edge. While respecting the basilar border, sectioning is then performed up to the gonial angle where bicortical section is finally performed. Sensibility of the labial and chin area was evaluated immediately postoperatively, and at six months and two years of follow up. A total of 140 eligible patients underwent the modified BSSO between January 2018 and December 2019, and 72 were included. Hypoaesthesia was found in 81.9% of the patients (59/72 patients) at initial evaluation. It decreased to 45.8% (33/72 patients) at the six-month examination and to 12.5% (9/72 patients) at the last examination. Four bad splits were recorded. The modified BSSO preserves the inferior border of the mandible and maintains the IAN in the lingual fragment. There is no need to release the IAN, hence its manipulation is reduced and the incidence of IAN postoperative hypoaesthesia is also reduced.
本研究的目的是评估保留下颌下缘的改良下颌双侧矢状劈开截骨术（BSSO）后下牙槽神经（IAN）神经感觉障碍的发生率。所有在2018年1月至2019年12月期间接受BSSO（无论是否联合Le Fort I截骨术，均由同一位资深手术医生操作）的患者均符合条件。改良BSSO是对Epker所描述技术的一种改进：颊侧皮质骨的截骨部位在距下颌骨基底边缘上方3 - 4毫米处停止。在保留基底边缘的同时，然后向上截骨至下颌角，最后在此处进行双侧皮质骨截骨。术后即刻、术后6个月和2年随访时评估唇部和颏部区域的感觉。2018年1月至2019年12月期间，共有140例符合条件的患者接受了改良BSSO，其中72例被纳入研究。初始评估时，81.9%的患者（59/72例）出现感觉减退。在6个月检查时，这一比例降至45.8%（33/72例），在最后一次检查时降至12.5%（9/72例）。记录到4例截骨不良情况。改良BSSO保留了下颌骨下缘，并使IAN保留在舌侧骨块中。无需游离IAN，因此减少了对其的操作，也降低了IAN术后感觉减退的发生率。
