Clinical Articles
A prospective electromyographic and computer-aided thermal sensitivity assessment of nerve lesions after sagittal split osteotomy and Le Fort I osteotomy*,**,*,**,*

https://doi.org/10.1053/joms.2001.20480Get rights and content

Abstract

Purpose: The purpose of this study was to determine the incidence of temporary and permanent sensory disturbance of the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy (BSSO) of the mandible and of the infraorbital nerve (ION) after Le Fort I osteotomy, as well as the rate of recovery of sensory function using subjective and objective measures. Patients and Methods: Preoperatively and after 1 week, and 1, 3, 6, and 12 months postoperatively, sensibility in the distribution of 36 IONs after Le Fort I osteotomy and 24 IANs after BSSO in 19 patients were investigated by using sharp-blunt testing, 2-point discrimination, electromyographic recording, and thermal sensitivity (Pain and Thermal Sensitivity Test Device [PATH]) tests of the Aδ and C nerve fibers. Results: With conventional clinical sharp-blunt and 2-point discrimination tests, the incidence of temporary impairment was 81% for the ION (29 of 36) and 83% for the IAN (20 of 24). The rate of permanent sensibility disturbance with conventional clinical testing was 6% for the ION and 15% for the IAN. Obvious recovery was found after 1 to 3 months for the ION, but it took 6 to 12 months for the IAN. In contrast, electromyography (EMG) testing showed lower rates of temporary sensory disturbance, namely, 54% (13 of 24) for the ION and 68% (15 of 22) for the IAN. Permanent sensory losses were not found. The results of the EMG test was confirmed by the PATH test. Conclusions: Objective tests for sensory disturbances show lower rates than the conventional tests. For quality control, preoperative and postoperative measurement and documentation of postoperative recovery of sensation is recommended. © 2001 American Association of Oral and Maxillofacial Surgeons

Section snippets

Patients

Orthognathic procedures were performed in 123 patients in the period between January 1996 and December 1997. Nineteen patients (11 males, 8 females) were randomized to the study from an overall population of 123 patients. All 19 patients were informed in detail about the various test modalities for checking sensibility status, both preoperatively and postoperatively, and all gave their consent to participate in the study. The average age of the patients was 24.9 years (range, 15 to 39 years).

Results

Preoperatively, all 19 patients had a uniform regular sensory status in the peripheral innervation areas of the ION and IAN on both sides. On the 7th postoperative day after the Le Fort I osteotomy, the sharp-blunt test indicated a sensory disturbance in 29 of 36 IONs investigated (81%) (Fig 3).

. Results of the sharp/blunt test following Le Fort I osteotomy (ION: n = 36). The following classification of sensibility was used: normal sensibility was based on the “passing” of 4 of 4 tests,

Discussion

In the prospective investigation of 36 IONs after Le Fort I osteotomy and 26 IANs after BSSO, it has been shown that with sharp-blunt testing and the 2-point discrimination test the incidence of transient sensory disturbances of the ION, namely 81% (29 of 36), is identical with the rate of transient disorders of the IAN of 83% (20 of 24). The rate of permanent sensory disturbance was shown by conventional clinical testing to be 6% for the ION and 15% for the IAN. Although an appreciable sensory

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  • Cited by (0)

    *

    *Senior Hospital Consultant, Department of Oral and Maxillofacial Surgery.

    **

    †Research Fellow, Department of Oral and Maxillofacial Surgery.

    *

    ‡Professor, Department of Prosthodontics.

    **

    §Professor, Department of Oral and Maxillofacial Surgery.

    *

    Address correspondence and reprint requests to Dr Schultze-Mosgau: Glueckstraβe 11, 91054 Erlangen, Germany; e-mail: [email protected]

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