Predictors of Inferior Alveolar Nerve Injury Following Bilateral Sagittal Split Osteotomy

Syeda Masooma; Imtiaz Ali; Asif Shah

doi:10.65293/jbkcd.v3i02.73

Authors

Syeda Masooma Senior Registrar, Department of Oral & Maxillofacial Surgery, Saidu College of Dentistry, Swat, Khyber Pakhtunkhwa, Pakistan.
Imtiaz Ali Department of Oral & Maxillofacial Surgery, Saidu College of Dentistry, Swat, Khyber Pakhtunkhwa, Pakistan.
Asif Shah Department of Oral Medicine, Saidu College of Dentistry, Swat, Khyber Pakhtunkhwa, Pakistan.

DOI:

https://doi.org/10.65293/jbkcd.v3i02.73

Keywords:

Inferior Alveolar Nerve Injury, Bilateral Sagittal Split Osteotomy, Orthognathic Surgery, Neurosensory Deficitm CBCT Nerve Proximity, Risk Factors, Logistic Regression

Abstract

Background: Inferior alveolar nerve (IAN) injury is a well-recognized complication following bilateral sagittal split osteotomy (BSSO). Identification of predictive factors is important for improving preoperative risk assessment and surgical outcomes. To evaluate demographic, radiographic, and intraoperative predictors of persistent inferior alveolar nerve injury following BSSO

Study Design: A Retrospective cohort Study

Place and Duration of Study: This study was conducted at the Department of Oral and Maxillofacial Surgery, Saidu College of Dentistry, Swat, Khyber Pakhtunkhwa, Pakistan, and included patients treated from January 2019 to December 2023.

Materials and Methods: A total of 300 patients who underwent bilateral sagittal split osteotomy (BSSO) for correction of dentofacial deformities were included in this retrospective analysis. Demographic characteristics, smoking status, cone-beam computed tomography (CBCT) measurements of nerve proximity, magnitude of mandibular movement, and intraoperative variables were recorded. The primary outcome was persistent IAN injury at 6 months postoperatively, assessed through patient-reported symptoms and clinical neurosensory examination. Bivariate associations were analyzed using chi-square tests, and significant variables were entered into a multivariate logistic regression model. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated.

Results: Immediate postoperative IAN injury occurred in 40% of patients, while 10% demonstrated persistent neurosensory deficit at 6 months. Independent predictors of persistent injury included high-risk nerve proximity on CBCT (AOR 4.72; 95% CI 1.98–11.23; p<0.001), bad split (AOR 6.75; p=0.004), mandibular movement ≥9 mm (AOR 3.85; p=0.002), intraoperative nerve exposure (AOR 3.41; p=0.006), smoking (AOR 2.96; p=0.021), IAN manipulation (AOR 2.89; p=0.022), age ≥35 years (AOR 2.48; p=0.045), and operative time ≥150 minutes (AOR 2.54; p=0.042).

Conclusion: Persistent IAN injury after BSSO is influenced by both anatomical and intraoperative factors. Preoperative CBCT risk assessment, minimization of nerve manipulation, and careful surgical technique may help reduce long-term neurosensory complications.

Author Biography

Syeda Masooma, Senior Registrar, Department of Oral & Maxillofacial Surgery, Saidu College of Dentistry, Swat, Khyber Pakhtunkhwa, Pakistan.

Corresponding Author: masoomadee90@gmail.com

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