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Impact of the mandibular divergence on the position of the inferior alveolar nerve and mylohyoid nerve: a computed tomography study and its relevance to bilateral sagittal split osteotomy

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Abstract

Purpose

Bilateral sagittal split osteotomy (BSSO) is the most common procedure used to treat mandibular deformities. BSSO procedures include the Epker technique and the Dal Pont technique which are the most frequently used. Because of the intramandibular pathway of the inferior alveolar nerve (IAN), neurosensory disturbance of the lower lip and chin is the most common complication of BSSO. This study performed quantitative measurements from computed tomographic (CT) data obtained on dry human mandibles. The main aim of the study was to evaluate if mandibular divergence can predict the position of the IAN and the mylohyoid nerve (MHN) to prevent nerve injury.

Methods

After CT and 3D reconstruction of 65 dry mandibles, 30 measurements were made on 3 planes for each hemi-mandible. This allowed analysis of the IAN and MHN pathways. Three groups of hemi-mandibles were created depending on their divergence, and a statistical analysis was performed.

Results

Eight out of the 30 measurements showed a significant difference among the 3 groups. There was no significant difference for the remaining 22 measurements.

Conclusions

The IAN seems to have a more superior position in the groups of mandibular hypo- and hyper-divergence. Orthognathic surgeons should use a more superficial retromolar bone incision in these cases. Finally, the Epker technique would be safer for preserving the MHN in normo- and hypo-divergent patients.

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References

  1. Dal Pont G (1961) Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv 19:42–47

    PubMed  CAS  Google Scholar 

  2. de Oliveira Júnior MR, Saud AL, Fonseca DR, De-Ary-Pires B, Pires-Neto MA, de Ary-Pires R (2011) Morphometrical analysis of the human mandibular canal: a CT investigation. Surg Radiol Anat 33:345–352

    Article  PubMed  Google Scholar 

  3. Epker BN (1977) Modifications in the sagittal osteotomy of the mandible. J Oral Surg 35:157–159

    PubMed  CAS  Google Scholar 

  4. Gola R (2006) Croissance mandibulaire selon Björk et croissance mandibulaire revisitée. In: Analyse céphalométrique de la face et du profil, 1st edn. Springer, Paris, pp 95–115

  5. Guyot L, Cheynet F, Faissal A, Gola R (1998) Le nerf de Valentin, son rôle dans l’innervation de la région mentonnière. Rev Stomatol Chir Maxillofac 99:106–114

    PubMed  CAS  Google Scholar 

  6. Guyot L, Seguin P, Benateau (2010) Ostéotomie mandibulaire par clivage sagittal des branches montantes. In: Techniques en chirurgie maxillo-faciale et plastique de la face, 1st edn. Springer, Paris, pp 51–56

  7. Hanzelka T, Foltán R, Pavliková G, Horká E, Sedý J (2011) The role of intraoperative positioning of the inferior alveolar nerve on postoperative paresthesia after bilateral sagittal split osteotomy of the mandible: prospective clinical study. Int J Oral Maxillofac Surg 40:901–906

    Article  PubMed  CAS  Google Scholar 

  8. Hwang K, Han JY, Chung IH, Hwang SH (2005) Cutaneous sensory branch of the mylohyoid nerve. J Craniofac Surg 16:343–345

    Article  PubMed  Google Scholar 

  9. Krasny A, Krasny N, Prescher A (2011) Study of inferior dental canal and its contents using high-resolution magnetic resonance imaging. Surg Radiol Anat. doi:10.1007/s00276-011-0910.y

  10. Lautner N, Krenkel C, McCoy M (2010) The intramandibular course of the inferior alveolar nerve and its clinical significance for distraction and implant treatment. Presented at the XX Congress of the EACMFS. Bruges, Belgium, 14–17 September, 2010

  11. Merrot O, Vacher C, Merrot S, Godlewski G, Frigard B, Goudot P (2005) Changes in the edentate mandible in the elderly. Surg Radiol Anat 27:265–270

    Article  PubMed  CAS  Google Scholar 

  12. Richter M, Mossaz C, de Tonnac N, Jaquinnet A, Laurent F, Goudot P (1997) Chirurgie correctrice des malformations ou “dysmorphies” maxillomandibulaires: “avant d’agir”. In: Encyclopédie médico-chirurgicale, Stomatologie. Elsevier, Paris, 22-066-C-10

  13. Richter M, Goudot P, Laurent F, Jaquinnet A, Bidaut L (1997) Chirurgie correctrice des malformations ou dysmorphies maxillomandibulaires: bases chirurgicales. In: Encyclopédie médico-chirurgicale, Stomatologie. Elsevier, Paris, 22-066-E-10

  14. Rouvière H, Dalmas A (1997) Nerfs Crâniens. In: Delmas V (ed) Anatomie humaine descriptive, topographique et fonctionnelle, Tome 1: Tête et cou, 14th edn. Masson, Paris, pp 249–300

    Google Scholar 

  15. Rusu MC, Sandulescu M, Ciuluvica RC, Sendroiu VM, Didilescu AC (2012) The extramandibular inferior alveolar nerve in cases with severely atrophic lower jaws. Surg Radiol Anat 34:277–279

    Article  PubMed  CAS  Google Scholar 

  16. Schudy FF (1965) The rotation of the mandible resulting from growth: its implication in orthodontic treatment. Angle Orthod 35:36–50

    PubMed  CAS  Google Scholar 

  17. Stein P, Brueckner J, Milliner M (2007) Sensory innervation of mandibular teeth by the nerve to the mylohyoid: implications in local anesthesia. Clin Anat 20:591–595

    Article  PubMed  Google Scholar 

  18. Teltzrow T, Kramer FJ, Schulze A, Baethge C, Brachvogel P (2005) Perioperative complications following sagittal split osteotomy of the mandible. J Craniomaxillofac Surg 33:307–313

    Article  PubMed  Google Scholar 

  19. Tom WK, Martone CH, Mintz SM (1997) A study of mandibular ramus anatomy and its significance to sagittal split osteotomy. Int J Oral Maxillofac Surg 26:176–178

    Article  PubMed  CAS  Google Scholar 

  20. Tsuji Y, Muto T, Kawakami J, Takeda S (2005) Computed tomographic analysis of the position and course of the mandibular canal: relevance to the sagittal split ramus osteotomy. Int J Oral Maxillofac Surg 34:243–246

    Article  PubMed  CAS  Google Scholar 

  21. Ulm CW, Solar P, Blahout R, Matejka M, Watzek G, Gruber H (1993) Location of the mandibular canal within the atrophic mandible. Br J Oral Maxillofac Surg 31:370–375

    Article  PubMed  CAS  Google Scholar 

  22. Van Sint Jan S (2007) Jaw. In: Thom D (ed) Color atlas of skeletal landmarks definition, 1st edn. Churchill Livingstone Elsevier, Edinburgh, pp 22–27

    Google Scholar 

  23. Watanabe H, Mohammad Abdul M, Kurabayashi T, Aoki H (2010) Mandible size and morphology determined with CT on a premise of dental implant operation. Surg Radiol Anat 32:343–349

    Article  PubMed  Google Scholar 

  24. Ylikontiola L, Kinnunen J, Oikarinen K (2000) Factors affecting neurosensory disturbance after mandibular bilateral sagittal split osteotomy. J Oral Maxillofac Surg 58:1234–1239 (discussion 1239–1240)

    Google Scholar 

  25. Yoshioka I et al (2011) Effect of bone quality and positon of the inferior alveolar nerve canal in continuous, long-term, neurosensory disturbance after sagittal split ramus osteotomy. J Craniomaxillofac Surg. doi:10.1016/j.jcms.2011.09.003

    PubMed  Google Scholar 

  26. Yu IH, Wong YK (2008) Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images. Int J Oral Maxillofac Surg 37:521–528

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Thanks to the firm Siemens to have placed a CT-scan at the disposal of Laboratory of Anatomy, Biomechanics and Organogenesis, which allowed us to conduct this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, Brussels, Belgium

    Olivier Oth & Régine Glineur

  2. Laboratory of Anatomy, Biomechanics and Organogenesis, Université Libre de Bruxelles, Route de Lennik, Brussels, Belgium

    Stéphane Louryan, Serge Van Sint Jan & Marcel Rooze

Authors
  1. Olivier Oth
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  2. Stéphane Louryan
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  3. Serge Van Sint Jan
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  5. Régine Glineur
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Correspondence to Olivier Oth.

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Oth, O., Louryan, S., Van Sint Jan, S. et al. Impact of the mandibular divergence on the position of the inferior alveolar nerve and mylohyoid nerve: a computed tomography study and its relevance to bilateral sagittal split osteotomy. Surg Radiol Anat 35, 241–247 (2013). https://doi.org/10.1007/s00276-012-1010-3

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  • DOI: https://doi.org/10.1007/s00276-012-1010-3

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