Immediate repair of transected inferior alveolar nerves in sagittal split osteotomies.
BACKGROUND
Injury to the inferior alveolar nerve (IAN) in orthognathic surgery is a well-documented complication with the incidence of IAN transection in sagittal split osteotomies (SSOs) ranging from 1.3% to 7.0%.


METHODS
We describe our clinical experience with 3 cases of immediate microneural repair of IANs transected during SSO.


RESULTS
Three cases of IAN transection (2 Sunderland degree V injuries, and 1 degree VI injury) that occurred during SSO were microsurgically repaired immediately by a trained microsurgeon. The other orthognathic surgery sites were positioned and fixed before the nerve repair commenced, and fixation of the nerve injury site was completed by the microsurgeon after nerve repair. All 3 patients were followed for at least 1 year with neurosensory testing, and showed recovery to mild or no sensory impairment. None had functional problems such as drooling, lip-biting, or speech difficulties at 1 year after surgery.


CONCLUSIONS
Immediate nerve repair for transected IANs during SSO may be a feasible option, but requires the availability of a microsurgeon, instrumentation, and operating-room time.
Tay
Andrew Ban Guan
AB
Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore. tinyknots@hotmail.com
Poon
Choy Yoke
CY
Teh
Luan Yook
LY
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D020209:Cranial Nerve Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008334:Mandible / Q000294:innervation / Q000601:surgery*; D019186:Mandibular Advancement / Q000009:adverse effects; D008340:Mandibular Nerve / Q000601:surgery*; D008866:Microsurgery; D009416:Nerve Regeneration; D019635:Neurosurgical Procedures / Q000379:methods*; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010027:Osteotomy / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D061221:Trigeminal Nerve Injuries; D055815:Young Adult