Sensory retraining after orthognathic surgery: effect on patient report of altered sensations.
ABSTRACT The purpose of this analysis was to determine whether, over a 2-year period after bilateral sagittal split osteotomy, patients who received facial sensory-retraining exercises with standard opening exercises in the first 6 months after surgery were as likely to report an alteration in facial sensation as those who received standard opening exercises only.
186 subjects were enrolled in a multi-center, double-blind, stratified-block, randomized clinical trial with 2 parallel groups. Patient reports of altered sensations were obtained before surgery, and 1, 3, 6, 12, and 24 months after surgery. A marginal model was fit to examine the effect of sensory retraining while controlling for potential explanatory effects related to demographic, psychological, and clinical factors on the odds of postoperative altered sensations being reported.
Age (P <0.0001) and severity of presurgical psychological distress (P <0.0001) were significantly associated with the presence of altered sensations after controlling for the exercise training received. After controlling for age and psychological distress, patients who received opening exercises only were approximately 2.2 times more likely to report postoperative altered sensations than those who also received sensory-retraining exercises (P <0.03).
These results suggest that a simple noninvasive exercise program started shortly after orthognathic surgery can lessen the likelihood that a patient will report altered sensations in the long term after orthognathic surgery.
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ABSTRACT: The purpose of this study was to review the current literature for the relationship between the preoperative position of the mandibular canal on three-dimensional (3D) radiographic imaging and postoperative neurosensory disturbance (NSD) following a sagittal split ramus osteotomy (SSRO). A literature search was conducted using PubMed, EMBASE, and the Cochrane Database for articles published from 1 January 2000 through 31 December 2013. Studies that included preoperative 3D imaging and assessment of NSD after surgery were reviewed. Study sample characteristics and results were extracted. Of the 69 articles identified, seven met the inclusion and exclusion criteria. There was no standardization for measuring the canal position or for evaluating NSD. General consensus was that the less space between the mandibular canal and the outer border of the buccal cortex the more frequent the occurrence of NSD. Increased bone density also appeared to contribute to a higher incidence of NSD. Utilization of 3D images to locate and measure the position of the mandibular canal is not standardized. Advances in 3D imaging and evaluation tools allow for new methodologies to be developed. Early attempts are informative, but additional studies are needed to verify the relationship between the location of the nerve and NSD following surgery.International Journal of Oral and Maxillofacial Surgery 05/2014; 43(9). DOI:10.1016/j.ijom.2014.03.020 · 1.36 Impact Factor
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ABSTRACT: Bilateral sagittal split ramus osteotomy (BSSO) is one of the most common procedures used in the treatment of mandibular deformity. One common complication of this surgical procedure is hypoesthesia of the inferior alveolar nerve. The authors hypothesized that perioperative local application of dexamethasone would have positive therapeutic effects on neurosensory function. This study investigated 18 patients (10 male, 8 female; mean age, 26.1 ± 4.9 yr) who underwent BSSO. One side of each patient's mandible was randomly selected as the control side and the opposite side as the experimental side. A solution of dexamethasone 4 mg/1 mL was drawn into a syringe and poured directly on the distal segment of the exposed inferior alveolar nerve during splitting and 1 mL was poured on the same nerve immediately before the start of fixation. Neurosensory tests, including light touch, direction of movement, static 2-point touch, thermal stimuli, and pin prick discrimination, were conducted. The χ(2) and Fisher exact tests were used to evaluate the data. The difference between the control and experimental groups at all intervals was not significant for any of the neurosensory tests. Local application of dexamethasone on the exposed inferior alveolar nerve during BSSO is not recommended.Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 01/2014; DOI:10.1016/j.joms.2013.12.025 · 1.28 Impact Factor
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ABSTRACT: After orthognathic surgery the forehead remains unchanged. To produce facial harmony, the planned projection of the maxillomandibular complex must be placed in the correct relations to the unchanged position of the forehead. We have compared the anterior soft tissue projection of the maxillomandibular complex relative to the forehead after Le Fort I advancement surgery for correction of maxillary hypoplasia with that of a local reference group chosen by lay assessors. We retrospectively studied 32 patients (16 men and 16 women) all of whom had previously been treated by Le Fort I maxillary advancement. In addition a panel of 8 lay assessors selected a reference group of 24 women and 16 men. Standard profile photographs were taken, and horizontal measurements made, of several landmarks from a true vertical line (TV) passing through glabella. Together with facial harmony values these were compared between the groups. The orthognathic group had significantly more anterior mandibular projection relative to the forehead than the female reference group (p=0.03). As a result half of the horizontal harmony values were smaller in the orthognathic group. For men the position of the mandible, particularly the chin, was acceptable even though it was positioned more anteriorly. We have provided values for maxillomandibular projection derived from lay assessors and identified areas where differences from those of a reference group were detected. The projection of the mid and lower face of the local reference group to the forehead should guide preoperative planning.British Journal of Oral and Maxillofacial Surgery 09/2014; 52(10). DOI:10.1016/j.bjoms.2014.08.017 · 1.13 Impact Factor