John Bobby, Poorna T Anish, E K Joshna, Philip George, Bharathi Arivarasan
Associate Professor, Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala, India.
Senior Resident, Department of Oral and Maxillofacial Surgery, Government Dental College, Kottayam, Kerala, India.
J Oral Maxillofac Surg. 2023 Mar;81(3):280-286. doi: 10.1016/j.joms.2022.12.008. Epub 2022 Dec 29.
A recently proposed modification of the sagittal split osteotomy (SSO) of the mandible places the horizontal medial cut 'low and short' of the lingula. The purpose of the study was to answer the following clinical question: Among patients undergoing mandibular setback procedures (≤ 8 mm) via SSO, does the placement of the medial horizontal osteotomy below the lingula (infralingular), when compared to placement above the lingula (supralingular), results in different neurosensory, bite force, and range of motion outcomes?
This was a single-center, double-blind, parallel-group study among patients undergoing mandibular setback by SSO (≤ 8 mm), between January 2021 and September 2022. Patients were randomly allocated in a ratio of 1:1 to the supralingular (control) and the infralingular (study) group. Primary outcome variables included neurosensory disturbance of the inferior alveolar nerve based on clinical neurosensory testing and severity graded using Zuniga and Essick's protocol, bite force, and maximum mouth opening evaluated postoperatively during the first week (T1), first month (T2), and third month (T3) of follow-up. Secondary outcome measures included the incidence of a bad split and distal segment interferences intraoperatively. Association between the variables was assessed using Pearson chi-squared test or Fisher's exact test based on the expected observations. A P value of ≤.05 was considered statistically significant.
A total of 29 patients (58 osteotomies) were included in the study. Group 1 consisted of 15 patients (9 females and 6 males) with a mean age of 26.4 years. Group 2 consisted of 14 patients (8 females and 6 males) with a mean age of 25.9 years. Patients with severe neurosensory disturbance of the inferior alveolar nerve were more common in group 2 (n = 15, 53.6%) than group 1 (n = 4, 13.3%) at T1 (P value = .0001) and insignificant between the two groups at T2 (P value = .63) and T3 (P value = .99). Comparison of maximum mouth opening between the two groups at T1 (P value = .535), T2 (P value = .934), and T3 (P value = .703) and bite force at T1 (P = .324), T2 (P = .113), and T3 (P = .811) was not significant.
Both SSO techniques have similar clinical outcomes among patients having mandibular setbacks (≤ 8 mm) for the variables studied.
最近有人提出对下颌骨矢状劈开截骨术（SSO）进行改良，将水平内侧截骨线置于舌骨下“低且短”的位置。本研究的目的是回答以下临床问题：在通过SSO进行下颌后缩手术（≤8毫米）的患者中，与将内侧水平截骨线置于舌骨上（舌骨上）相比，将其置于舌骨下（舌骨下）是否会导致不同的神经感觉、咬合力和运动范围结果？
这是一项于2021年1月至2022年9月期间，针对接受SSO下颌后缩手术（≤8毫米）患者的单中心、双盲、平行组研究。患者按1:1的比例随机分配至舌骨上（对照组）和舌骨下（研究组）。主要结局变量包括基于临床神经感觉测试的下牙槽神经神经感觉障碍，并使用祖尼加和埃西克的方案进行严重程度分级、咬合力以及在随访的第一周（T1）、第一个月（T2）和第三个月（T3）术后评估的最大张口度。次要结局指标包括术中不良劈开和远心段干扰的发生率。根据预期观察结果，使用Pearson卡方检验或Fisher精确检验评估变量之间的关联。P值≤0.05被认为具有统计学意义。
本研究共纳入29例患者（58处截骨）。第1组由15例患者（9例女性和6例男性）组成，平均年龄26.4岁。第2组由14例患者（8例女性和6例男性）组成，平均年龄25.9岁。在T1时，第2组（n = 15，53.6%）下牙槽神经严重神经感觉障碍的患者比第1组（n = 4，13.3%）更常见（P值 = 0.0001），在T2（P值 = 0.63）和T3（P值 = 0.99）时两组之间无显著差异。两组在T1（P值 = 0.535）、T2（P值 = 0.934）和T3（P值 = 0.703）时的最大张口度以及在T1（P = 0.324）、T2（P = 0.113）和T3（P = 0.811）时的咬合力比较均无显著差异。
对于所研究的变量，两种SSO技术在接受下颌后缩（≤8毫米）的患者中具有相似的临床结果。
