J Korean Assoc Oral Maxillofac Surg.  2020 Feb;46(1):41-48. 10.5125/jkaoms.2020.46.1.41.

Preoperative imaging of the inferior alveolar nerve canal by cone-beam computed tomography and 1-year neurosensory recovery following mandibular setback through bilateral sagittal split ramus osteotomy: a randomized clinical trial

Affiliations
  • 1Department of Oral and Maxillofacial Surgery and Implant Research Center, Islamic Azad University, Tehran Dental Branch, Tehran, Iran. hamidmahaseni@gmail.com
  • 2Department of Dental Anatomy, Dental School, Islamic Azad University, Tehran, Iran.
  • 3Craniomaxillofacial Research Center, Islamic Azad University, Tehran Dental Branch, Tehran, Iran.

Abstract


OBJECTIVES
One of the most common complications of bilateral sagittal split ramus osteotomy (BSSRO) is neurosensory impairment of the inferior alveolar nerve (IAN). Accurate preoperative determination of the position of the IAN canal within the mandible using cone-beam computed tomography (CBCT) is recommended to prevent IAN dysfunction during BSSRO and facilitate neurosensory improvement after BSSRO.
MATERIALS AND METHODS
This randomized clinical trial consisted of 86 surgical sites in 43 patients (30 females and 13 males), including 21 cases (42 sides) and 22 controls (44 sides). Panoramic and lateral cephalographs were obtained from all patients. In the experimental group, CBCT was also performed from both sides of the ramus and mandibular body. Neurosensory function of the IAN was subjectively assessed using a 5-point scale preoperatively and 7 days, 1 month, 3 months, 6 months, and 12 months post-surgery. Data were analyzed using Fisher's test, Spearman's test, t-test, linear mixed-model regression, and repeated-measures ANCOVA (α=0.05, 0.01).
RESULTS
Mean sensory scores in the control group were 1.57, 2.61, 3.34, 3.73, and 4.20 over one year and were 1.69, 3.00, 3.60, 4.19, and 4.48 in the CBCT group. Significant effects were detected for CBCT intervention (P=0.002) and jaw side (P=0.003) but not for age (P=0.617) or displacement extent (P=0.122).
CONCLUSION
Preoperative use of CBCT may help surgeons to practice more conservative surgery. Neurosensory deficits might heal faster on the right side.

Keyword

Cone-beam computed tomography; Randomized clinical trial

MeSH Terms

Cone-Beam Computed Tomography*
Female
Humans
Jaw
Mandible
Mandibular Nerve*
Osteotomy, Sagittal Split Ramus*
Surgeons
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