악교정 수술 후 감각소실에 관한연구

NEUROSENSORY DEFICIT AFTER ORTHOGNATHIC SURGERY

  • 류성호 (원광대학교 치과대학 산본치과병원 구강악안면외과) ;
  • 조영철 (울산동강병원 치과/구강악안면외과) ;
  • 손장호 (울산대학교 의과대학 울산대학교병원 치과/구강악안면외과) ;
  • 성일용 (울산대학교 의과대학 울산대학교병원 치과/구강악안면외과) ;
  • 장현호 (울산대학교 의과대학 서울아산병원 구강악안면외과) ;
  • 김재승 (울산대학교 의과대학 서울아산병원 구강악안면외과)
  • Ryu, Sung-Ho (Dept. of Oral & Maxillofacial Surgery, Sanbon Dental Hospital, College of Dentistry, Wonkwang University) ;
  • Cho, Young-Chul (Dept. of Oral & Maxillofacial Surgery, Ulsan Dong Kang Hospital) ;
  • Son, Jang-Ho (Dept. of Oral & Maxillofacial Surgery, Medical College of Ulsan University) ;
  • Sung, Iel-Yong (Dept. of Oral & Maxillofacial Surgery, Medical College of Ulsan University) ;
  • Chang, Hyun-Ho (Dept. of Oral & Maxillofacial Surgery, Medical College of Ulsan University, Asan Medical Center) ;
  • Kim, Jae-Seung (Dept. of Oral & Maxillofacial Surgery, Medical College of Ulsan University, Asan Medical Center)
  • 발행 : 2004.12.31

초록

Aims: This study was designed to determine the incidence of altered sensation in patients undergoing orthognathic surgery. Method: Seventy two patients who underwent orthognathic surgery between January, 1999 and December, 1999 constituted the study group. Seven patients were excluded because of lack of follow up. Sixty five patients were followed using objective and subjective neurologic testing during the period immediately following operation, 1 month, 2 months, 6 months, and 1 year postoperatively. Age ranged from 17 to 38 years, with a mean of 24.5 years. Male patients were 21, female 44. Twenty eight bilateral sagittal splitting ramus osteotomy(BSSRO) of mandible were performed, 35 BSSRO with genioplasty, 2 genioplasties. Information on the degree of intraoperative nerve encounter was obtained from the surgical reports in 47 patients and was divided into the following three categories: (1) the nerve was not encountered in 23 patients; (2) the nerve was exposed in 11 patients; (3) the nerve was exposed and repositioned from the proximal segment in 13 patients. Results: Four patients reported altered nerve sensation of lower lip and/or chin(6.2%) at final follow up. Two patients underwent BSSRO and the other two patients BSSRO with genioplasty. Three of the patients underwent nerve exposure during the operation. Conclusion: We suggest that the nerve exposure during the operation might be partly responsible for nerve dysfunction after orthognathic surgery.

키워드

참고문헌

  1. Kaneshige Satoh: Mandibular Contouring Surgery by Angular Contouring Combined with genioplasty in Orientals. Plast Reconstr Surg 1998;101:461
  2. Kim JS : Orthognathic surgery of mandibular prognathism. 1st ed. Korea. W. B. Jisung 1999;P32-35
  3. Trauner R, Obwegeser HL: The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. Part I. Surgical procedures to correct mandibular porgnathism and reshaping of chin. Oral Med Oral Pathol 1957;10:889-909
  4. Dal Pont G: Retromolar osteotomy for correction of prognathism. J Oral Surg Anesth Hosp D Serv 1961;19:42-47
  5. Hunsuck EE: A modified intraoral sagittal splitting technique for correction of mandibular prognathism. J Oral Maxillofac Surg 1986;26:250-253
  6. Epker BN: Modifications in the sagittal osteotomy of the mandible. J Oral Maxillofac Surg 1977;35:157-159
  7. Westermark A, Englesson L: Neurosensory function after sagittal split osteotomy of the mandible: A comparison between subjective evaluation and objective assessment. Int J Adult Orthod Orthognath Surg 1999;14:268-275
  8. Nakagawa K, Ueki K, Matsumoto N, Takatsuka S, Yamamoto E, Ooe H: The assessment of trigeminal sensory merve paresthesia after bilateral sagittal split osteotomy: Modified somatosensory evoked potentials recording method. J Craniomaxillofac Surg 1997;25:97-101 https://doi.org/10.1016/S1010-5182(97)80052-2
  9. August M, Marchena J, Donady J, Kaban L: Neurosensory deficit and functional impairment after sagittal ramus osteotomy: A long-term follow-up study. J Oral Maxillofac Surg 1998;56:1231-1235 https://doi.org/10.1016/S0278-2391(98)90595-X
  10. Westermark A, Bystedt H: Patients’evaluation of the final result of sagittal split osteotomy: Is it influenced by impaired sensitivity of the lower lip and chin? Int J Adult Orthod Orthognath Surg 1999;14:135-139
  11. Jones DL, Wolford LM: Comparison of methods to assess alterations following orthognathic surgery. Int J Adult Orthod Orthognath Surg 1990;5:35-42
  12. Brusati R. Fiamminghi L, Sesenna E, Gazzotti A: Functional disturbances of the inferior alveolar nerve after sagittal osteotomy of the mandibular ramus: operation technique for prevention. J Maxillofac Surg 1981;9:123-125
  13. Ylikontiola L, Kinnunen J, Oikarinen K: Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 1998;27:417-421 https://doi.org/10.1016/S0901-5027(98)80028-3
  14. Cunningham LL, Tiner BD, Clark GM, Miloro M, Davis LF: A comparison of questionnaire versus monofilament assessment of neurosensory deficit. J Oral Maxillofac Surg 1996;54:454-459 https://doi.org/10.1016/S0278-2391(96)90120-2
  15. Fridrich KL, Holton TJ, Pansegrau KJ, Buckley MJ: Neurosensory recovery following the mandibular bilateral sagittal split osteotomy. Oral Maxillofac Surg 1995;53:1300-1306 https://doi.org/10.1016/0278-2391(95)90588-X
  16. Coghaln KM, GH Irvine: Neurological damage after sagittal split osteotomy. Int J Maxillofac 15;1986:369
  17. Leira JI, Gilhuus-Moe OT: Sensory impairment following sagittal split osteotomy for correction of mandibular retrognathism. Int J Adult Orthod Orthognath Surg 1991;6:161-167
  18. Westermark A, Bystedt H, von Konow L: Inferior alveolar nerve function after mandibular osteotomies. Br J Oral Maxillofac Surg 1998;36:425-428 https://doi.org/10.1016/S0266-4356(98)90457-0
  19. Chen N, Neal CE et al: Neuroensory changes following orthognathic surgery. Int J Adult Orthod Orthognath Surg 1999;14:259-267
  20. George L, Rajvanakarn M, Hayward JR: Evaluation of the regenerative capacity of the inferior alveolar nerve following surgical trauma. J Oral Maxillofac Surg 1987;45:212-216 https://doi.org/10.1016/0278-2391(87)90117-0
  21. Yoshida T, Nagamine T, Kobayashi T, et al: Impairement of the inferior alveolar nerve after sagittal split osteotomy. J Craniomaxillofac Surg 1998;17:271-278
  22. Karas ND, Boyd SB, Sinn DP: Recovery of neurosensory function following orthognathic surgery. J Oral Maxillofac Surg 1990;48:124-134 https://doi.org/10.1016/S0278-2391(10)80199-5
  23. Nishioka GH, Zysset MK, Sickel JE: Neurosensory disturbance with rigid fixation of the bilateral sagittal split osteotomy. J Oral Maxillofacial Surg 1987:45:20-26
  24. Posnick JC, Al-Quattan MM, Stepner NM: Alteration in facial sensibility in adolescents following sagittal split and chin osteotomies of the mandible. Plast Reconstr Surg 1996;97:920
  25. Westermark A, Bystedt H, von Konow L: Inferior alveolar nerve function after sagittal split osteotomy of the mandible: Correlation with degree of intraoperative nerve encounter and other variables in 496 operations. Br J Oral Maxillofac Surg 1998;36:429-433 https://doi.org/10.1016/S0266-4356(98)90458-2
  26. Pratt CA, Tippett H, Barnard JDW, Birnie DJ: Labial sensory function following sagittal split osterotmy. Br J Oral Maxillofac Surg 1996;34:75-81 https://doi.org/10.1016/S0266-4356(96)90141-2
  27. Sunderland S: Anatomical features of nerve trunks in relation to nerve injury and nerve repair. Clin Neurosurg 1969;17:38