Posnick J C, Al-Qattan M M, Stepner N M
Division of Plastic Surgery at the Georgetown Craniofacial Center, USA.
Plast Reconstr Surg. 1996 Apr;97(5):920-7. doi: 10.1097/00006534-199604001-00006.
Static two-point discrimination, pressure, and vibratory threshold values were measured bilaterally at standard coordinates in the area of the face innervated by the mental nerve in 115 adolescents (230 nerves). The patients were divided into four groups: normal adolescents who had not undergone any orthognathic surgery (group I controls, n = 134 nerves, mean age 18 years, SD = 3), those 1 year after undergoing bilateral sagittal split osteotomies of the mandible (group II, n = 14 nerves, mean age 19 years, SD = 2), those 1 year after undergoing an osteoplastic genioplasty (group III, n = 40, mean age 19 years, SD = 3), and those 1 year after undergoing a combination of bilateral sagittal split osteotomies and an osteoplastic genioplasty (group IV, n = 42 nerves, mean age 19 years, SD = 3). Subjective residual numbness at the 1 year postoperative interval was reported by 2 of 7 patients in group II, 2 of 20 patients in group III, and 14 of 21 patients (67 percent) in group IV. Long-term subjective numbness involved only the chin skin in 16 of 18 patients experiencing residual numbness and was perceived as problematic in the remaining 2 (group IV) patients whose subjective numbness also was measured objectively in the chin, lower lip (mucosa and skin), and gingiva. Objectively, the mean threshold values of the three sensory modalities tested were higher in group IV patients than in the remaining groups at all coordinates tested, but significant differences (p < 0.05) were found only between the mean two-point discrimination of group IV patients and the control group in the region of the chin skin. The high percentage of patients documented to have subjective and objective sensory disturbance after undergoing a combination of sagittal split osteotomies of the mandible and an osteoplastic genioplasty (group IV) may be explained by the "double crush syndrome."
在115名青少年（230条神经）由颏神经支配的面部区域的标准坐标处双侧测量静态两点辨别觉、压力觉和振动觉阈值。患者被分为四组：未接受任何正颌手术的正常青少年（I组对照，n = 134条神经，平均年龄18岁，标准差 = 3）；接受双侧下颌矢状劈开截骨术后1年的患者（II组，n = 14条神经，平均年龄19岁，标准差 = 2）；接受骨成形性颏成形术后1年的患者（III组，n = 40条神经，平均年龄19岁，标准差 = 3）；接受双侧下颌矢状劈开截骨术和骨成形性颏成形术联合手术1年的患者（IV组，n = 42条神经，平均年龄19岁，标准差 = 3）。II组7例患者中有2例、III组20例患者中有2例以及IV组21例患者中有14例（67%）报告术后1年时有主观残余麻木感。18例有残余麻木感的患者中，16例的长期主观麻木仅累及颏部皮肤，其余2例（IV组）患者的主观麻木在颏部、下唇（黏膜和皮肤）及牙龈处也进行了客观测量，他们认为主观麻木是个问题。客观上，在所有测试坐标处，IV组患者所测试的三种感觉模式的平均阈值均高于其余组，但仅在颏部皮肤区域，IV组患者的平均两点辨别觉与对照组之间存在显著差异（p < 0.05）。接受下颌矢状劈开截骨术和骨成形性颏成形术联合手术（IV组）后有主观和客观感觉障碍的患者比例较高，这可能可用“双重压迫综合征”来解释。
