Neurosensory Disturbances after Bilateral Sagittal Split Osteotomy using Piezoelectric Surgery: A Systematic Review

Publication date: Available online 3 July 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Kristian Rude, Peter Svensson, Thomas Starch-Jensen
PurposeThe objective of the present systematic review was to test the hypothesis of no difference in neurosensory disturbances after bilateral sagittal split osteotomy with piezoelectric surgery compared to conventional techniques.Materials and MethodsA PubMed (MEDLINE), Embase Library, and Cochrane Library search in combination with a hand-search of relevant journals were conducted from January 2000 to November 2017. Randomized controlled trials and controlled trials in humans were considered. Primary outcome measures (assessment of neurosensitivity by subjective and objective evaluation), secondary outcome measures (neurosensory disturbance risk factors, patient-reported outcome measures, complications, operating time and intraoperative bleeding).ResultsThe search provided 241 studies of which five eligible studies were included. Meta-analysis was not possible due to considerable heterogeneity. Two studies were characterized by a moderate risk of bias and three by a high risk of bias. Piezoelectric surgery significantly diminish neurosensory disturbances as evaluated by subjective tests. Neurosensory disturbance after bilateral sagittal split varied between 1.8 to 23.0% with piezoelectric surgery, and 7.3 to 52.0% with conventional techniques, after 2 to 12 months. Furthermore, piezoelectric surgery seems to significantly reduce the frequency of intraoperative bleeding in bimaxillary procedures, and diminish the risk of an unfavorable split of the mandible and macroscopic damage of the inferior alveolar nerve.ConclusionsIn conclusion, the hypothesis of no difference in NSD after BSSO with piezoelectric surgery compared to conventional techniques could neither be confirmed nor rejected due to insufficient knowledge. However, piezoelectric surgery seems to diminish the risk of neurosensory disturbances after bilateral sagittal split osteotomy compared to conventional techniques. Long-term randomized controlled trails comparing the two treatment modalities by standardized subjective and objective electrophysiological tests are needed before one treatment modality can be considered superior to another.



https://ift.tt/2KIjPuZ