Comparison of the effects of ultrasonic and conventional surgery on the neurosensory disturbance after bilateral sagittal split osteotomy

Publication date: Available online 3 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Shinya Kokuryo, Manabu Habu, Ryosuke Kita, Takeshi Katsuki, Kazuhiro Tominaga, Izumi Yoshioka
PurposeAccording to the literature, ultrasonic surgery reduces the incidence of neurosensory disturbance (NSD) of the inferior alveolar nerve (IFAN) after bilateral sagittal split osteotomy (BSSO). The purpose of the present study was to evaluate the effects of ultrasonic surgery and the anatomical position of the IFAN canal on NSD after BSSO.Patients and methodsThis retrospective cohort study included skeletal mandibular prognathism cases operated using an ultrasonic bone scalpel or a reciprocating saw. The primary predictor variable was osteotomy technique (ultrasonic or conventional surgery). The primary outcome variable was NSD. Other variables included age, sex, operator, degree of setback, surgical duration, blood loss, and the position of the IFAN. Comparisons of two variables were performed using Student's t-test or Fisher's exact test. A regression model was used to examine the relationship between presence or absence of NSD and other variables. The level of significance was set at p < 0.05 for all statistical tests.ResultsThe ultrasonic group was composed of 35 patients, while the conventional group was composed of 32 patients. Three months after surgery, NSD was observed on 16 (22.9%) of 70 sides in the ultrasonic group and 28 (43.8%) of 64 sides in the conventional group; this difference was significant. Furthermore, recovery from NSD at 3 months after BSSO was significantly more common in the ultrasonic group than in the conventional group. In the ultrasonic group, even when the distance from the buccal aspect of the IFAN canal to the outer buccal cortical margin was shorter, NSD of the IFAN was less frequent.ConclusionUltrasonic surgery may be an effective technique to reduce the incidence of NSD after BSSO, and it contributed to recovery from NSD. The use of an ultrasonic device for BSSO is recommended when the distance from the buccal aspect of the IFAN canal to the outer buccal cortical margin is shorter on CT.



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