Immediate Repair of Transected Inferior Alveolar Nerves in Sagittal Split Osteotomies
Background
Injury to the inferior alveolar nerve (IAN) in orthognathic surgery is a well-documented complication with the incidence of IAN transection in sagittal split osteotomies (SSOs) ranging from 1.3% to 7.0%.
Patients and Methods
We describe our clinical experience with 3 cases of immediate microneural repair of IANs transected during SSO.
Results
Three cases of IAN transection (2 Sunderland degree V injuries, and 1 degree VI injury) that occurred during SSO were microsurgically repaired immediately by a trained microsurgeon. The other orthognathic surgery sites were positioned and fixed before the nerve repair commenced, and fixation of the nerve injury site was completed by the microsurgeon after nerve repair. All 3 patients were followed for at least 1 year with neurosensory testing, and showed recovery to mild or no sensory impairment. None had functional problems such as drooling, lip-biting, or speech difficulties at 1 year after surgery.
Conclusion
Immediate nerve repair for transected IANs during SSO may be a feasible option, but requires the availability of a microsurgeon, instrumentation, and operating-room time.
⁎Consultant, Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore
†Director and Senior Consultant, Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore
‡Senior Consultant, Department of Oral and Maxillofacial Surgery, National Dental Centre, Singapore
Address correspondence and reprint requests to Dr Tay: Department of Oral and Maxillofacial Surgery, National Dental Centre, 5 Second Hospital Avenue, Singapore 168938, Singapore
ABSTRACT