From the Craniofacial Center, Division of Oral and Maxillofacial Surgery, and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital; and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington.
Plast Reconstr Surg. 2024 Oct 1;154(4):773e-780e. doi: 10.1097/PRS.0000000000011047. Epub 2023 Sep 6.
The purpose of this study was to evaluate the recovery of lingual nerve (LN) neurosensory function in patients undergoing sagittal split osteotomy (SSO) with a low and short medial horizontal cut.
This was a prospective study of patients with mandibular deformities undergoing SSO with a low and short medial horizontal cut over a 4-year period. The outcomes of interest were neurosensory recovery of the LN, as assessed objectively using functional sensory recovery (FSR) and subjectively by patient report.
The sample included 123 SSOs in 62 subjects with a mean age of 19.3 ± 3.1 years. Thirty-seven subjects (61.7%) were female. Mandibular advancements were performed in 52 SSOs (42.3%); mandibular setbacks were performed in 71 SSOs (57.7%). One subject underwent revision BSSO. FSR was achieved at 122 LNs (99.1%) within 6 weeks postoperatively, with 120 sites (97.5%) having S4 sensation at 6 weeks. Decreased LN sensation was reported at 10 (8.3%) sites at 1 week postoperatively. At 6 weeks postoperatively, 118 sites (97.5%) had reported normal sensation. By 12 weeks postoperatively, all LN sites had S4 sensation and there were no subjective complaints. Revision sagittal split osteotomy was associated with prolonged (≥6 weeks) time to S4 sensation ( P = 0.02) and subjective complaint of decreased sensation ( P = 0.02).
LN sensory recovery occurs rapidly following the low and short SSO, with 99% of sites achieving FSR and subjectively normal sensation within 6 weeks of surgery and all patients achieving FSR with S4 sensation by 12 weeks postoperatively. LN sensory recovery may be prolonged in patients undergoing revision SSO.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
本研究旨在评估行低位短水平颏舌骨肌神经（LN）切开的下颌骨矢状劈开截骨术（SSO）患者 LN 神经感觉功能的恢复情况。
这是一项前瞻性研究，纳入了 4 年内接受低位短水平颏舌骨肌神经切开的下颌骨畸形 SSO 患者。感兴趣的结局是 LN 神经感觉的恢复情况，客观评估采用功能感觉恢复（FSR），主观评估采用患者报告。
样本包括 62 例患者的 123 例 SSO，平均年龄 19.3±3.1 岁，其中 37 例（61.7%）为女性。52 例 SSO 行下颌骨前徙（42.3%），71 例 SSO 行下颌骨后退（57.7%）。1 例患者行二次 BSSO。术后 6 周内 122 个 LN（99.1%）实现 FSR，6 周时 120 个部位（97.5%）具有 S4 感觉。术后 1 周时，10 个部位（8.3%）报告 LN 感觉减退。术后 6 周时，118 个部位（97.5%）报告感觉正常。术后 12 周时，所有 LN 部位均具有 S4 感觉，且无主观不适。二次 SSO 与 S4 感觉（P=0.02）和感觉减退的主观报告（P=0.02）时间延长（≥6 周）相关。
行低位短水平 SSO 后，LN 感觉恢复迅速，99%的部位在术后 6 周内实现 FSR 和主观感觉正常，所有患者在术后 12 周时均实现 FSR 和 S4 感觉。行二次 SSO 的患者 LN 感觉恢复可能延长。
临床问题/证据水平：治疗性，IV。
