title: Nerve manipulation during bilateral sagittal split osteotomy increases neurosensory disturbance and decreases patient satisfaction.
abstract: OBJECTIVE
  The extent to which neurosensory disturbance (NSD) affects patients after bilateral sagittal split osteotomy (BSSO) was investigated 1 year postoperatively. An additional aim was to identify related factors.
  
  
  METHODS
  In this prospective study, the fate of the mandibular nerve during BSSO was recorded. The predictor variable was the degree of nerve injury during BSSO, and the outcome variable was the effect of NSD 1 year postoperatively. Statistics were computed and a P value less than .05 was considered significant.
  
  
  RESULTS
  Forty-one patients (27 women; average age, 37 yr) completed the study. Of these patients, 90.2% had NSD, but most (89.2%) were satisfied with the treatment and would choose it again. The NSD was greater when the nerve had been manipulated more during surgery. The 4 patients with visible nerve lacerations had severe NSD and were unsatisfied with the treatment at the endpoint.
  
  
  CONCLUSIONS
  Although NSD was frequent 1 year after BSSO, most patients were satisfied with the treatment. However, a risk for severe NSD or neuropathic pain does exist in a small group of patients. These patients should be identified at an early stage so that proper medical and supportive treatment can be initiated. If necessary, a multidisciplinary pain center should be consulted. The importance of accurate patient information preoperatively cannot be overstated.
authors.affiliation: Consultant, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: marina.kuhlefelt@hel.fi.
authors.forename: Marina
authors.initials: M
authors.lastname: Kuhlefelt
authors.affiliation: Professor and Head, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Laine
authors.affiliation: Head, Department of Oral Public Health, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland; Department of Oral and Maxillofacial Surgery, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Suominen
authors.affiliation: Professor and Head, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Christian
authors.initials: C
authors.lastname: Lindqvist
authors.affiliation: Head, Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Thorén
mesh_terms: D000328:Adult; D000367:Age Factors; D001294:Attitude to Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000601:surgery; D019186:Mandibular Advancement / Q000379:methods / Q000523:psychology; D008340:Mandibular Nerve / Q000473:pathology*; D008875:Middle Aged; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods* / Q000523:psychology; D010149:Postoperative Pain / Q000209:etiology; D064406:Patient Harm; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000523:psychology; D011446:Prospective Studies; D012678:Sensation Disorders / Q000209:etiology* / Q000523:psychology; D012737:Sex Factors; D012907:Smoking; D016896:Treatment Outcome; D061221:Trigeminal Nerve Injuries / Q000209:etiology*; D014277:Trigeminal Neuralgia / Q000209:etiology; D055815:Young Adult