Effect of facial sensory re-training on sensory thresholds

Does mandibular osteotomy affect the infraorbital nerve? a prospective study

OBJECTIVES

The aim of this study was to evaluate the sensory function of the infraorbital nerve after orthognathic surgery (OS).

MATERIALS AND METHODS

Patients who underwent Le Fort I osteotomy with or without BSSO for dentofacial deformity treatment were studied. Two groups were created according to whether BSSO was performed. Class A tests were performed to determine the degree of peripheral nerve damage. The Class B test was performed if decreased sensation was detected in at least one of these tests. A Class C test was performed if abnormal sensation was detected.

RESULTS

Twenty-eight patients (n=56) who underwent OS were included in this prospective study. Of the patients, 57.1% were female, 42.9% were male, and the mean age was 24.6 (±3.8). Seven patients were in group 1 (n=14), and 21 patients were in group 2 (n=42). In both groups, there were statistically significant differences between T1 and T2 (p<0.001), and the mean NSD score at T2 was higher than that at T1. The mean NSD score in the single jaw group was higher than that in the double jaw group at all time points.

CONCLUSIONS

Bimaxillary surgeries had a negative effect on the somatosensory changes that developed in the early period. The upper lip's somatosensorial recovery was faster than IOR and single jaw recovery was faster than double jaw.

CLINICAL RELEVANCE

Maxillofacial surgeons performing orthognathic surgery should be aware that in double jaw operations, changes in the somatosensory function of the ION are more severe.

Virtual surgical planning for treatment of severe mandibular retrognathia with collapsed occlusion using contemporary surgical and prosthodontic protocols

PURPOSE

To meet functional and esthetic needs in an older adult for treatment of complex skeletal and dentoalveolar deformities using contemporary surgical and prosthodontic protocols.

METHODS

An older adult with dentoalveolar complex and skeletal deformity (mandibular retrognathia) was treated by a combination of virtual planning and current surgical and prosthodontic protocols. Treatment planning steps and sequencing are presented.

RESULTS

Skeletal, soft tissue, and dental harmonies were attained without biological or mechanical complications. Definitive oral rehabilitation was completed with a maxillary complete denture and a mandibular metal ceramic fixed implant-retained prosthesis.

CONCLUSIONS

A surgical and prosthodontic team approach in combination with technologic advances can predictably optimize esthetic and functional outcomes for patients with complex skeletal and dentoalveolar deformities.

Non-invasive therapy for altered facial sensation following orthognathic surgery: an exploratory randomized clinical trial of intranasal vitamin B12 spray

AIM

The aim of the study was to obtain pilot data on the putative effects of intranasal spray Vitamin B12 in lessening the impairment from orthognathic surgery on large and small diameter nerve fiber functions.

METHODS

Thirty-five subjects scheduled for a mandibular osteotomy were enrolled in an open-label two-group parallel stratified-block randomized clinical trial: Intranasal Vitamin B12 Spray (B12), with weekly doses self-administered two weeks before until 6 months after surgery, or no intranasal spray. All subjects received sensory retraining exercises. Large fiber tactile (contact detection) and small fiber thermal (warm, cool, heat discomfort, and cold discomfort) thresholds were obtained before and at 1, 3, and 6 months after surgery. For each, the mean maximum impairment was estimated for group and visit, controlling for age and type of surgery.

RESULTS

The demographics and pre-surgery threshold values of the two groups did not differ (P>0.16). At and 6 months after surgery, serum B12 levels were substantially higher in the B12 group (P<0.01). At one month post, average impairment for every threshold measure was less for the B12 group. From 1 to 3 months, the differences between the two groups decreased for the tactile measures but stayed the same (cool and warm perception) or increased (cold and heat discomfort perception) for the thermal measures. At 6 months, the B12 group remained less impaired for the thermal measures.

CONCLUSION

This pilot RCT indicates that the effects of intranasal Vitamin B12 spray, initiated prior to surgery, on sensory function are sufficiently promising to justify progression to a Phase III RCT.

Sensory retraining: a cognitive behavioral therapy for altered sensation

Sensory retraining teaches the patient to ignore or blot out postinjury unpleasant orofacial sensations to optimally tune into and decipher the weakened and damaged signals from the tissues. Sensory retraining is a simple, inexpensive, noninvasive exercise program, which initiated shortly after injury, can lessen the objectionable impression of orofacial altered sensations. Sensory retraining exercises are most effective on decreasing the perceived burden associated with hypoesthetic orofacial altered sensations.

Inferior alveolar nerve injury following orthognathic surgery: a review of assessment issues

The sensory branches of the trigeminal nerve encode information about facial expressions, speaking and chewing movements, and stimuli that come into contact with the orofacial tissues. Whatever the cause, damage to the inferior alveolar nerve negatively affects the quality of facial sensibility as well as the patient's ability to translate patterns of altered nerve activity into functionally meaningful motor behaviours. There is no generally accepted, standard method of estimating sensory disturbances in the distribution of the inferior alveolar nerve following injury. Assessment of sensory alterations can be conducted using three types of measures: (i) objective electrophysiological measures of nerve conduction, (ii) sensory testing (stimulus) measures and (iii) patient report. Each type of measure with advantages and disadvantages for use are reviewed.

Sensory retraining: burden in daily life related to altered sensation after orthognathic surgery, a randomized clinical trial

OBJECTIVE

Assess the long-term effect of sensory retraining exercises, age, gender, type of surgery, and pre-surgical psychological distress on patients' perception of the interference related to altered sensation 2 years after orthognathic surgery.

SETTING AND SAMPLE POPULATION

A total of 186 subjects with a developmental dentofacial disharmony were enrolled in a multicenter randomized clinical trial: one center was a community-based practice and the other a university-based center.

METHODS AND MATERIALS

Subjects were randomly allocated to two groups: standard of care mouth opening exercises after BSSO or a progressive series of sensory retraining facial exercises in addition to the opening exercises. At 1, 3, 6, 12, and 24 months after surgery, subjects scored unusual feelings on the face, numbness, and loss of lip sensitivity from 'no problem (1)' to 'serious problem (7)'. A marginal proportional odds model was fit for each of the ordinal outcomes.

RESULTS

Up to 2 years after surgery, the opening exercise only group had a higher likelihood of reporting interference in daily activities related to numbness and loss of lip sensitivity than the sensory retraining exercise group. The difference between the two groups was relatively constant. Older subjects and those with elevated psychological distress before surgery reported higher burdens related to unusual facial feelings, numbness, and loss of lip sensitivity (p < 0.02).

CONCLUSION

The positive effect of sensory retraining facial exercises observed after surgery is maintained over time. Clinicians should consider the patient's age and psychological well-being prior to providing pre-surgical counseling regarding the impact on daily life of persistent altered sensation following a mandibular osteotomy.