title: Risk factors for neurosensory disturbance after bilateral sagittal split osteotomy based on position of mandibular canal and morphology of mandibular angle.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the potential morphologic risk factors for postoperative neurosensory disturbance (NSD) after bilateral sagittal split osteotomy.
  
  
  METHODS
  The study subjects were 30 skeletal Class III patients (9 males and 21 females), with a mean age of 22.0 years (range, 16-39 years). All patients underwent bilateral sagittal split osteotomy for setback to correct mandibular prognathism. The bone marrow space between the outer mandibular canal and the lateral cortex of the ramus was measured on transaxial computed tomography images, and the length at the mandibular angle between the retromolar and gonion was measured on the lateral cephalograms. The NSD was tested bilaterally using discrimination to touch with the sharp head of a mechanical probe. Each patient was evaluated at 1, 3, and 6 months postoperatively.
  
  
  RESULTS
  The median bone marrow space was 1.96 mm (range, 0-4.5 mm), and median length of the mandibular angle was 30.93 mm (range, 23-37 mm). Neurosensory disturbance was present on 15 sides (25.0%) at 1 month postoperatively, 9 sides (15.0%) at 3 months postoperatively, and 7 sides (11.7%) at 6 months postoperatively. The difference in the incidence of NSD with a small bone marrow space and a long mandibular angle from that with a large bone marrow space and short mandibular angle was highly statistically significant (P = .006 and P < .01, respectively).
  
  
  CONCLUSIONS
  The frequency of NSD after bilateral sagittal split osteotomy in Class III cases was dependent not only on the position of mandibular canal, but also on the length of the mandibular angle. A lateral course of the mandibular canal and a long mandibular angle appeared to result in a high risk of injury to the inferior alveolar nerve, resulting in NSD owing to a compromised splitting procedure.
authors.affiliation: Division of Oral and Maxillofacial Reconstructive Surgery, Kyushu Dental College, Kitakyushu, Fukuoka, Japan. k-yama@kyu-dent.ac.jp
authors.forename: Kensuke
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Tetsu
authors.initials: T
authors.lastname: Takahashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kaneuji
authors.forename: Shinnosuke
authors.initials: S
authors.lastname: Nogami
authors.forename: Noriaki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Ikuya
authors.initials: I
authors.lastname: Miyamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000000981:diagnostic imaging; D002508:Cephalometry / Q000379:methods; D003724:Dental Arch / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery; D008334:Mandible / Q000294:innervation / Q000473:pathology / Q000601:surgery*; D008340:Mandibular Nerve / Q000503:physiopathology; D059229:Osteotomy, Sagittal Split Ramus / Q000009:adverse effects* / Q000295:instrumentation; D011183:Postoperative Complications; D011378:Prognathism / Q000601:surgery; D012307:Risk Factors; D012684:Sensory Thresholds / Q000502:physiology; D020886:Somatosensory Disorders / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014110:Touch / Q000502:physiology; D061221:Trigeminal Nerve Injuries / Q000209:etiology*; D055815:Young Adult