Page 31 - Read Online

Topic: Peripheral Nerve Repair and Regeneration

Neuropathic pain after bilateral sagittal split

osteotomy: management and prevention

Jimoh Olubanwo Agbaje , Ivo Lambrichts , Reinhilde Jacobs , Constantinus Politis 1,3
1
3
1,2
1 Department of Imaging and Pathology, Faculty of Medicine, Catholic University of Leuven, 3000 Leuven, Belgium.
2 Department of Oral and Maxillofacial Surgery, St. John’s Hospital, 3600 Genk, Belgium.
3 Faculty of Medicine, Morphology Research Group, Hasselt University, 3590 Diepenbeek, Belgium.
Address for correspondence: Prof. Constantinus Politis, Department of Imaging and Pathology, Faculty of Medicine, Catholic University of
Leuven, 3000 Leuven, Belgium. E-mail: constantinus.politis@uzleuven.be

ABSTRACT
Neuropathic pain is characterized by spontaneous and provoked pain and other signs reflecting neural
damage. Aberrant regeneration following peripheral nerve lesions leaves neurons unusually sensitive
and prone to spontaneous pathological activity, abnormal excitability and heightened sensitivity to
stimuli. This review covers the current understanding of neuropathic pain after bilateral sagittal split
osteotomy (BSSO) of the lower jaw. The reported incidence of neuropathic pain after mandibular
osteotomies is less than 1%, while the incidence in patients with iatrogenic inferior alveolar nerve (IAN)
injuries during BSSO can be as high as 45%. The factors which modulate the healing process toward
neuropathic pain during or after nerve damage have not yet been elucidated. Patients at highest risk
for developing post-BSSO neuropathic pain are older than 45 years and have undergone procedures
involving IAN compression, partial severance, or complete discontinuity of the lingual nerve with
a proximal stump neuroma, patients with nerve injury repair delayed longer than 12 months and
patients with chronic illnesses that compromise healing or increase risk for peripheral neuropathy.
Although neuropathic pain tends to be long-lasting, some patients can recover completely. Preventive
measures include risk assessment prior to surgery, prevention of nerve damage during surgery, and
early repair of nerve injury.
Key words:
Bilateral sagittal split osteotomy, incidence, management, neuropathic pain, risk factor

INTRODUCTION adjacent tissue. These damaged nerve fibers in turn send
incorrect signals to other pain centers. [3]
Neuropathic pain is a complex, chronic pain state caused Neuropathic pain is characterized by spontaneous and
[1]
by a lesion of the somatosensory nervous system. It provoked pain mostly of a burning character, by positive
usually results from tissue injury and excludes pain from a symptoms such as paresthesias and dysesthesias, and by
[2]
condition preceding surgery. Neuropathic pain can arise negative signs (sensory deficits) reflecting neural damage.
from damage to the nerve pathways at any point from Sensory disturbances in the area of surgery show a
the terminals of the peripheral nociceptors to the cortical strikingly strong association with persistent postsurgical
neurons in the brain. In this type of pain, nerve fibers pain, suggesting nerve damage as a contributing factor in
may be damaged, dysfunctional, or injured, resulting in a a significant portion of cases. [2,3] Many investigations have
change in nerve function at both the site of injury and
confirmed the relevance of surgery as the initiating event
for the development of persistent pain, even after a minor
Access this article online operation, such as tooth extraction. [1]
Quick Response Code:
Website: Bilateral sagittal split osteotomy (BSSO) is a common
www.parjournal.net
procedure used to treat mandibular deformity. Because
mandibular osteotomies are performed in close proximity
DOI: to the neurovascular bundle in the mandibular canal, there
10.4103/2347-9264.160880 is a high risk of injury to the inferior alveolar nerve (IAN). [4‑6]
IAN injury during surgery largely results from manipulation

Plast Aesthet Res || Vol 2 || Issue 4 || Jul 15, 2015 171