Morbidity of harvesting of chin grafts: a prospective study.
In a prospective study, 20 patients who underwent harvesting of chin grafts as outpatients, were followed up for 12 months (3 further patients with incomplete follow-up data were excluded from the study). Preoperatively and 7 days, 1, 3, 6 and 12 months postoperatively, follow-up data were assessed. Evaluation of the superficial sensory function of the inferior alveolar nerve was determined by the Pointed-Blunt Test and the Two-Point-Discrimination Test. Sensory disturbances were objectively assessed by testing thermal sensitivity with the "Pain and Thermal Sensitivity" Test (PATH Test). In addition, evaluation of the pulp sensitivity of teeth 35-45 was carried out by cold vitality testing. One week postoperatively, 8 patients were affected by superficial sensory impairment. 8 nerve territories showed hypoaesthetic reactions and 5 showed hyperaesthetic reactions. After 12 months, two patients still suffered from hypoaesthesia of one side of the chin. There was a statistically significant sensitivity impairment of the chin for all patients comparing the preoperative data of the Two-Point-Discrimination Test (left/right median: 8.17/8.17 mm, interquartile range (IQR) 1.00/2.00 mm) with the first postoperative measurement (left/right median 9.00/8.33 mm, IQR 1.67/2.66 mm). Comparing the latter to the last postoperative measurement there was significant tendency for regeneration of a nerve function (left/right median 8.00/7.84 mm, IQR 0.66/2.00 mm). In the PATH Test all hypoaesthetic areas could be identified by a reduction of thermal sensitivity. After the first postoperative examination 21.6% (n=38/176) of the examined teeth had lost their pulp sensitivity. After 12 postoperative months 11.4% (n=20/176) still did not react sensitively. Many of these were canines (n=8/20). Comparing the preoperative to the first postoperative examination, there was a significant reduction of pulp sensitivity. However, statistically significant recovery until the last postoperative follow-up could not be detected. The assessed data show that patients have to be informed extensively about disturbances of the inferior alveolar nerve function lasting longer than 12 months. Moreover, the loss of pulp sensitivity is a very frequent event which has always to be taken into account. Considering the high rate of complications with harvesting of chin grafts, more prospective trials should be done to find out whether there are other donor sites for autogenous bone which put less strain on patients.
Nkenke
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E
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany. emeka.nkenke@mkg.imed.uni-erlangen.de
Schultze-Mosgau
S
S
Radespiel-Tröger
M
M
Kloss
F
F
Neukam
F W
FW
D000556:Ambulatory Surgical Procedures; D016025:Bone Transplantation; D002680:Chin / Q000294:innervation; D003080:Cold Temperature; D003481:Cuspid / Q000294:innervation; D003782:Dental Pulp / Q000294:innervation; D005500:Follow-Up Studies; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology; D006987:Hypesthesia / Q000209:etiology; D008340:Mandibular Nerve / Q000503:physiopathology; D009416:Nerve Regeneration / Q000502:physiology; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012677:Sensation / Q000502:physiology; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013696:Temperature; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*; D014110:Touch / Q000502:physiology; D014182:Transplantation, Autologous