A prospective electromyographic and computer-aided thermal sensitivity assessment of nerve lesions after sagittal split osteotomy and Le Fort I osteotomy.
OBJECTIVE
The purpose of this study was to determine the incidence of temporary and permanent sensory disturbance of the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy (BSSO) of the mandible and of the infraorbital nerve (ION) after Le Fort I osteotomy, as well as the rate of recovery of sensory function using subjective and objective measures.


METHODS
Preoperatively and after 1 week, and 1, 3, 6, and 12 months postoperatively, sensibility in the distribution of 36 IONs after Le Fort I osteotomy and 24 IANs after BSSO in 19 patients were investigated by using sharp-blunt testing, 2-point discrimination, electromyographic recording, and thermal sensitivity (Pain and Thermal Sensitivity Test Device [PATH]) tests of the Adelta and C nerve fibers.


RESULTS
With conventional clinical sharp-blunt and 2-point discrimination tests, the incidence of temporary impairment was 81% for the ION (29 of 36) and 83% for the IAN (20 of 24). The rate of permanent sensibility disturbance with conventional clinical testing was 6% for the ION and 15% for the IAN. Obvious recovery was found after 1 to 3 months for the ION, but it took 6 to 12 months for the IAN. In contrast, electromyography (EMG) testing showed lower rates of temporary sensory disturbance, namely, 54% (13 of 24) for the ION and 68% (15 of 22) for the IAN. Permanent sensory losses were not found. The results of the EMG test was confirmed by the PATH test.


CONCLUSIONS
Objective tests for sensory disturbances show lower rates than the conventional tests. For quality control, preoperative and postoperative measurement and documentation of postoperative recovery of sensation is recommended.
Schultze-Mosgau
S
S
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Germany. stefan.schultze-mosgau@mkg.imed.uni-erlangen.de
Krems
H
H
Ott
R
R
Neukam
F W
FW
D000293:Adolescent; D000328:Adult; D020209:Cranial Nerve Injuries / Q000175:diagnosis* / Q000209:etiology*; D004192:Discrimination, Psychological; D004576:Electromyography; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008340:Mandibular Nerve / Q000503:physiopathology; D009416:Nerve Regeneration; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D009915:Orbit / Q000294:innervation; D010027:Osteotomy / Q000009:adverse effects; D019340:Osteotomy, Le Fort / Q000009:adverse effects; D017063:Outcome Assessment, Health Care / Q000379:methods; D010147:Pain Measurement / Q000295:instrumentation / Q000379:methods; D020886:Somatosensory Disorders / Q000175:diagnosis* / Q000209:etiology*; D013223:Statistics as Topic; D061221:Trigeminal Nerve Injuries