title: Influence of BSSO surgical technique on postoperative inferior alveolar nerve hypoesthesia: a systematic review of the literature.
abstract: OBJECTIVE
  The aim of this study was to evaluate the influence of different splitting techniques, namely, "mallet and chisel" versus "spreading and prying", used during bilateral sagittal split osteotomy (BSSO) on postoperative hypoesthesia outcomes.
  
  
  METHODS
  We systematically searched the PubMed and Cochrane databases (from January 1957 to November 2012) for studies that examined postoperative neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) after BSSO.
  
  
  RESULTS
  Our initial PubMed search identified 673 studies, of which, 14 met our inclusion criteria. From these 14 studies, 3 groups were defined: (1) no chisel use (4.1% NSD/site), (2) undefined chisel use (18.4% NSD/site), and (3) explicit chisel use along the buccal cortex (37.3% NSD/site).
  
  
  CONCLUSIONS
  Study heterogeneity and a frequent lack of surgical detail impeded our ability to make precise comparisons between studies. However, the group of studies explicitly describing chisel use along the buccal cortex showed the highest incidence of NSD. Moreover, comparison of the study that did not use chisels with the 2 studies that explicitly described chisel use revealed a possible disadvantage of the "mallet and chisel" group (4.1% versus 37.3% NSD/site). These results suggest that chisel use increases NSD risk after BSSO.
authors: Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands; Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J.P.R. van Merkesteyn), Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: GMensink1@amphia.nl.
authors: Gertjan
authors: G
authors: Mensink
authors: Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands; Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. D. Bloomquist), University of Washington, Seattle, USA; Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Amsterdam Medical Centre, Amsterdam, The Netherlands.
authors: Peter J J
authors: PJ
authors: Gooris
authors: Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands.
authors: J Eelco
authors: JE
authors: Bergsma
authors: Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands; Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J. de Lange), Amsterdam Medical Centre, Amsterdam, The Netherlands.
authors: Erik
authors: E
authors: van Hooft
authors: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. J.P.R. van Merkesteyn), Leiden University Medical Centre, Leiden, The Netherlands.
authors: J P Richard
authors: JP
authors: van Merkesteyn
mesh_terms: D006801:Humans; D006987:Hypesthesia / Q000209:etiology*; D008340:Mandibular Nerve / Q000503:physiopathology*; D059229:Osteotomy, Sagittal Split Ramus / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D061221:Trigeminal Nerve Injuries / Q000209:etiology
keywords: BSSO; Bilateral sagittal split osteotomy; Chisels; Inferior alveolar nerve; Nerve injury; Neurosensory disturbance