Management of the Inferior Alveolar Nerve in Large Sagittal Split Advancements: To Free or Not? 2023

Benjamin B Massenburg, and Philip D Tolley, and Russell E Ettinger, and Srinivas M Susarla
From the Craniofacial Center, Divisions of Plastic and Craniofacial Surgery and Oral and Maxillofacial Surgery, Seattle Children's Hospital; and Department of Surgery, Division of Plastic Surgery, and Department of Oral and Maxillofacial Surgery, University of Washington.

The purpose of this study was to evaluate whether neurosensory recovery of the inferior alveolar nerve (IAN) is influenced by its location following sagittal split osteotomy (SSO) in patients undergoing large mandibular movements. This was a prospective, split-mouth study of skeletally mature patients undergoing bilateral SSO. Patients were included as study subjects if they underwent bilateral SSO for mandibular advancement greater than 10 mm and, following the splits, the IAN was freely entering the distal segment on one side and within the proximal segment on the other. Descriptive, bivariate, and Kaplan-Meier statistics were computed. The study sample included 13 subjects (eight female subjects; mean age, 18.7 ± 1.8 years) undergoing 26 SSOs. Eleven subjects underwent bimaxillary surgery; 10 had simultaneous genioplasty. The mean mandibular movement was 12.2 ± 1.4 mm and was not significantly different between sides ( P = 0.43). All subjects achieved functional sensory recovery (FSR) bilaterally within 1 year of surgery. There was no difference in the median times to FSR based on the location of the IAN (distal segment, 105 days, versus proximal segment, 126 days; P = 0.57). In SSO for mandibular advancement with movements greater than 10 mm, leaving the IAN within the proximal segment may not impact time to FSR. Risk, II.

UI MeSH Term Description Entries
D008334 Mandible The largest and strongest bone of the FACE constituting the lower jaw. It supports the lower teeth. Mylohyoid Groove,Mylohyoid Ridge,Groove, Mylohyoid,Grooves, Mylohyoid,Mandibles,Mylohyoid Grooves,Mylohyoid Ridges,Ridge, Mylohyoid,Ridges, Mylohyoid
D008340 Mandibular Nerve A branch of the trigeminal (5th cranial) nerve. The mandibular nerve carries motor fibers to the muscles of mastication and sensory fibers to the teeth and gingivae, the face in the region of the mandible, and parts of the dura. Alveolar Nerve, Inferior,Auriculotemporal Nerve,Buccal Nerve,Deep Temporal Nerve,Lateral Pterygoid Nerve,Masseteric Nerve,Mental Nerve,Mylohyoid Nerve,Auriculotemporal Nerves,Buccal Nerves,Deep Temporal Nerves,Inferior Alveolar Nerve,Inferior Alveolar Nerves,Lateral Pterygoid Nerves,Mandibular Nerves,Masseteric Nerves,Mental Nerves,Mylohyoid Nerves,Nerve, Auriculotemporal,Nerve, Buccal,Nerve, Deep Temporal,Nerve, Inferior Alveolar,Nerve, Lateral Pterygoid,Nerve, Mandibular,Nerve, Masseteric,Nerve, Mental,Nerve, Mylohyoid,Pterygoid Nerve, Lateral,Pterygoid Nerves, Lateral,Temporal Nerve, Deep,Temporal Nerves, Deep
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D055815 Young Adult A person between 19 and 24 years of age. Adult, Young,Adults, Young,Young Adults
D059229 Osteotomy, Sagittal Split Ramus Sagittal sectioning and repositioning of the ramus of the MANDIBLE to correct a mandibular retrusion, MALOCCLUSION, ANGLE CLASS III; and PROGNATHISM. The oblique sectioning line consists of multiple cuts horizontal and vertical to the mandibular ramus. Sagittal Split Ramal Osteotomy,Sagittal Split Ramus Osteotomy
D061221 Trigeminal Nerve Injuries Traumatic injuries to the TRIGEMINAL NERVE. It may result in extreme pain, abnormal sensation in the areas the nerve innervates on face, jaw, gums and tongue and can cause difficulties with speech and chewing. It is sometimes associated with various dental treatments. Cranial Nerve V Injury,Fifth Cranial Nerve Injuries,Fifth Cranial Nerve Injury,Fifth-Nerve Palsy, Traumatic,Fifth-Nerve Trauma,Injury, Cranial Nerve V,Injury, Fifth Cranial Nerve,Traumatic Fifth-Nerve Palsy,Trigeminal Nerve Avulsion,Trigeminal Nerve Contusion,Trigeminal Nerve Injury,Trigeminal Nerve Transection,Trigeminal Nerve Trauma,Trigeminal Neuropathy, Traumatic,Avulsion, Trigeminal Nerve,Avulsions, Trigeminal Nerve,Contusion, Trigeminal Nerve,Contusions, Trigeminal Nerve,Fifth Nerve Palsy, Traumatic,Fifth Nerve Trauma,Fifth-Nerve Palsies, Traumatic,Fifth-Nerve Traumas,Injuries, Trigeminal Nerve,Injury, Trigeminal Nerve,Nerve Avulsion, Trigeminal,Nerve Avulsions, Trigeminal,Nerve Contusion, Trigeminal,Nerve Contusions, Trigeminal,Nerve Injuries, Trigeminal,Nerve Injury, Trigeminal,Nerve Transection, Trigeminal,Nerve Transections, Trigeminal,Nerve Trauma, Trigeminal,Nerve Traumas, Trigeminal,Neuropathies, Traumatic Trigeminal,Neuropathy, Traumatic Trigeminal,Palsies, Traumatic Fifth-Nerve,Palsy, Traumatic Fifth-Nerve,Transection, Trigeminal Nerve,Transections, Trigeminal Nerve,Trauma, Fifth-Nerve,Trauma, Trigeminal Nerve,Traumas, Fifth-Nerve,Traumas, Trigeminal Nerve,Traumatic Fifth Nerve Palsy,Traumatic Fifth-Nerve Palsies,Traumatic Trigeminal Neuropathies,Traumatic Trigeminal Neuropathy,Trigeminal Nerve Avulsions,Trigeminal Nerve Contusions,Trigeminal Nerve Transections,Trigeminal Nerve Traumas,Trigeminal Neuropathies, Traumatic

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