Postoperative neurosensory impairment perception using ultrasonic BoneScalpel and conventional rotary instruments after bilateral split sagittal osteotomy

Abstract

Purpose

Although bilateral sagittal split osteotomy (BSSO) is the most widely used surgical technique for the correction of mandibular dentofacial anomalies, it is associated with lesion of inferior alveolar nerve (IAN) and unwanted neurosensory disorders. The aim of this study was to document the perception of changes in sensitivity and mean recovery time after BSSO, using an ultrasonic BoneScalpel versus the conventional rotary instruments.

Patients and methods

This retrospective observational study included all patients with diagnosis of skeletal anomaly who underwent advancement or setback BSSO of less than 10 mL, using the ultrasonic osteotome or conventional rotary instruments. The patients were operated on at the Hospital Universitario Clínica San Rafael, Bogotá Colombia, between 2017 and 2018. The primary predictor variable was the osteotomy technique. The primary outcome was the presence or absence of postoperative sensory alteration, whereas secondary outcomes were time of appearance and recovery, affected anatomical region, laterality, and disturbance in daily activities. Data were analyzed using Chi-square, Mann-Whitney U, and Fisher’s exact test.

Results

Data of 38 patients were retrieved, of which 23 were operated with BoneScalpel and 13 with the conventional technique. Twenty patients were women and 18 were men. All patients reported experiencing at least one type of sensory disturbance immediately after the surgical procedure. There was a significant difference (p = 0.0001) in the time that the alteration was present between the two groups, in favor of the BoneScalpel group. The chin and the lower lip were the anatomical regions with the greatest alteration in sensitivity and persistence of it.

Conclusions

The results of this study indicate that BoneScalpel is effective in performing BSSO. They also suggest that it may reduce the occurrence of nerve damage during BSSO, although more research on this topic is required.

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Correspondence to Andrés Gómez-Delgado.

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Ethical approval was obtained from the ethics committee of the Hospital Universitario Clínica San Rafael (Reference number: CEI-060-2019).

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The authors declare no competing interests.

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Video 1.

Time of effective use of the BoneScalpel. Note that the time is approximately 2 minutes. (MP4 152613 kb)

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Ruiz Valero, C.A., Gómez-Delgado, A. & Henao-Moreno, N. Postoperative neurosensory impairment perception using ultrasonic BoneScalpel and conventional rotary instruments after bilateral split sagittal osteotomy. Oral Maxillofac Surg (2021). https://doi.org/10.1007/s10006-021-00945-z

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Keywords

  • Sagittal split osteotomy
  • BoneScalpel
  • Ultrasonic osteotome
  • Orthognathic surgery