title: Lingual nerve injury in association with sagittal ramus osteotomy and bicortical screw fixation: a review of 523 procedures in 262 subjects.
abstract: The purpose of this study was to assess the frequency of irreversible lingual nerve (LN) injury in patients undergoing sagittal ramus osteotomies (SRO) with bicortical screw fixation. A retrospective cohort study of patients treated by a single surgeon was performed (follow-up 2-11 years). The sample consisted of a series of subjects with a bimaxillary dentofacial deformity (DFD). The SRO and bicortical screw fixation techniques were consistent. The primary outcome variable was the prevalence of irreversible LN injury. Two hundred sixty-two subjects undergoing 523 SROs with bicortical screw fixation met the inclusion criteria. Average age at operation was 25 years (range 13-63 years) and there were 134 females (51%). The majority of SROs were fixated with three bicortical screws (92%). Simultaneous third molar removal was done in 209 of the 523 SROs (40%). For primary mandibular deficiency subjects (n=40), the mean mandibular advancement was 11.0mm (range 5-17mm), with 42.5% undergoing counter-clockwise rotation. In the study group (n=523 SRO's) there was one irreversible LN injury (<1%). This study confirmed a lack of association of LN injury at the time of SRO with sex, age at operation, simultaneous removal of a third molar, use of bicortical screw fixation, pattern of DFD, and extent of mandibular advancement.
authors.affiliation: Posnick Center for Facial Plastic Surgery, Georgetown University, Washington, DC, USA; School of Dentistry, University of Maryland, Baltimore, MD, USA; Howard University College of Dentistry, Washington, DC, USA. Electronic address: jposnick@drposnick.com.
authors.forename: J C
authors.initials: JC
authors.lastname: Posnick
authors.affiliation: Howard University College of Dentistry, Washington, DC, USA.
authors.forename: E
authors.initials: E
authors.lastname: Choi
authors.affiliation: Posnick Center for Facial Plastic Surgery, Georgetown University, Washington, DC, USA.
authors.forename: N
authors.initials: N
authors.lastname: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D006801:Humans; D061222:Lingual Nerve Injuries / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008964:Molar, Third / Q000601:surgery; D059229:Osteotomy, Sagittal Split Ramus / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: bicortical screw fixation; lingual nerve injury; sagittal ramus osteotomy