title: Bilateral sagittal split osteotomy versus distraction osteogenesis of the mandible: a randomized clinical trial.
abstract: A randomized clinical trial was performed to evaluate differences in postoperative neurosensory disturbance (NSD) between two methods of mandibular advancement surgery. A total of 66 non-syndromal class II patients with mandibular hypoplasia were randomized for either distraction osteogenesis (DO) or bilateral sagittal split osteotomy (BSSO). Twenty-nine patients in the BSSO group and 34 patients in the DO group were available for evaluation. Objective assessment was performed by Semmes-Weinstein (SW) monofilament testing preoperatively and at least 1 year after surgery. Six of the 34 patients (17.6%) in the DO group experienced objective NSD, compared to 5/29 patients (17.2%) in the BSSO group. In the evaluation of nerve function by individual nerves, 8/68 nerves (11.8%) revealed objective NSD in the DO group, compared to 7/58 nerves (12.1%) in the BSSO group. A subjective NSD was reported in 11/34 patients (32.4%) in the DO group, compared to 9/29 patients (31.0%) in the BSSO group. In the evaluation of nerve function by individual nerves, a subjective NSD was reported for 13/68 nerves (19.1%) in the DO group, compared to 13/58 nerves (22.4%) in the BSSO group. None of the differences was significant. No differences in neurosensory disturbance could be found between the two study groups. Objective WS monofilament testing appeared to underestimate NSD compared to subjective patient report.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Isala, Zwolle, Netherlands. Electronic address: e.m.baas@isala.nl.
authors.forename: E M
authors.initials: EM
authors.lastname: Baas
authors.affiliation: Department of Oral and Maxillofacial Surgery, Isala, Zwolle, Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Bierenbroodspot
authors.affiliation: Department of Oral and Maxillofacial Surgery, Isala, Zwolle, Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Centre/Academic Centre for Dentistry (ACTA), University of Amsterdam, Amsterdam, Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: de Lange
mesh_terms: D000293:Adolescent; D020209:Cranial Nerve Injuries / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000601:surgery*; D019186:Mandibular Advancement / Q000379:methods*; D009426:Netherlands; D019857:Osteogenesis, Distraction; D059229:Osteotomy, Sagittal Split Ramus; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: RCT; complication; distraction osteogenesis; mandibular advancement; mandibular distraction; mandibular retrognathia; neurosensory disturbance; sagittal split osteotomy