Analysis of Studies on Orthognathic Surgery

[rachaelrosen]

From a study on patients from 1998 to 2005 in Korea, which followed 301 patients:

"The most frequent postoperative complication was sensory impairment, seen in 196 cases (65.1%), followed by respiratory difficulty in 63 (20.9%), neck pain in 25 (8.3%), anterior open bite in 12 (4.0%), and gastrointestinal disease in 4 (1.3%). Other complications were fever, headache, and infection. Table 4 summarizes these results.

Sensory impairment in this article refers to the patients who experience unexpected, unpleasant sensations and have difficulty performing common activities with the face and mouth.21"

"Inferior alveolar nerve numbness was present in 96 cases (73.3%) of sagittal split ramus osteotomy only. Walter and Gregg34 followed mandibular osteotomy patients for 6 months and reported that all patients showed mental nerve numbness immediately after surgery and 84.6% of the patients exhibited neuropathies after prolonged observation. They also reported that the numbness persisted in patients older than 40 years of age."

This is post operative, so while only 1.3% of patients experienced nerve exposure during the operation, almost all of them experienced numbness after surgery, including in prolonged tests.

Source: https://www.joms.org/article/S0278-2391(07)01633-3/fulltext

I've heard it quoted multiple times that permanent nerve damage is very rare, but I have only been able to find sources following patients up to six months after the operation. Does anyone have a source on long term nerve damage?

 

[enlighten99]

Maybe check real self reviews and updates from patients but it seems plenty of surgeons cut above the nerve line and there’s numbness

 

[rachaelrosen]

Update Here's from another study:

"Verweij et al.39 reported that hypoesthesia following SSRO occurred in 4.8% of patients aged less than 19 years, in 7.9% of patients aged between 19-30 years, and in 15.2% in patients aged 31 years or older. Although the rate of permanent hypoesthesia that persisted until one year after SSRO was low, the mean recovery time from hypoesthesia was relatively long for older patients. In other words, old age is a risk factor for permanent hypoesthesia. The rate of inferior alveolar nerve injury varies from study to study due to the lack of standardized assessment and reporting methods. Therefore, a majority of assessments of inferior alveolar nerve injury performed to date has used subjective methods. An international consensus meeting must be organized with the purpose of establishing standardized methods of assessing the degree of nerve injuries40.

de Vries et al.41 reported nine cases of facial nerve paralysis among 1,747 patients who underwent SSRO. The rate of facial nerve paralysis reported by other scholars varies from 0.17% to 0.75%."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342970/#__sec7title

Notice that these numbers are much lower than the previous study's.

"An international consensus meeting must be organized with the purpose of establishing standardized methods of assessing the degree of nerve injuries."

Different studies report nerve damage differently. In this study, https://www.ijoms.com/article/S0901-5027(17)30455-1/abstract doctors describe how 71% of patients report numbness, but only 32% of patients were found to have objective neurosensory deficit and only 7% said it significantly affected them, with 70.9% of patients stating it did not affect them at all.