DOI QR코드

DOI QR Code

Case report: Treatment of Facial Nerve Palsy Following Bilateral Sagittal Split Ramus Osteotomy

증례보고 : 양측 하악지 시상골 절단술 후 발생한 안면신경 마비

  • Ryu, Ji-Won (Department of Oral medicine, School of Dentistry, Chosun University)
  • 유지원 (조선대학교 치의학전문대학원 구강내과학교실)
  • Received : 2013.07.15
  • Accepted : 2013.08.06
  • Published : 2013.09.30

Abstract

Bilateral sagittal split ramus osteotomy(BSSRO) of the mandible is an essential and commonly used procedure to correct dentofacial deformities and malocclusion. The possible complications associated with BSSRO include inferior alveolar nerve injury, bleeding, temporomandibular disorder, unfavorable fractures, and clinical relapse. The incidence of facial nerve palsy after orthognathic surgery recently reported is 0.1%. The probable etiologies have included facial nerve compression, complete or incomplete nerve transection, nerve traction, and nerve ischemia from anesthetic injection. Postoperative facial palsy is one of the most serious complications because it reduces the quality of life and significantly reduces social interaction. The case of a 24-year-old patient who underwent bilateral sagittal split ramus osteotomy is described. The medical records and postoperative photographs were reviewed in detail to collect information on the clinical course, treatment, and outcomes.

양측 하악지 시상 골절단술은 악안면 기형 및 부정교합을 치료하기 위해 흔히 사용되는 필수불가결한 술식이라고 할 수 있다. 하악지 시상 골절단술 후 발생할 수 있는 합병증으로는 하치조 신경 손상, 출혈, 측두하악장애, 부적절한 골면의 유합 및 골절, 재발 등이 있다. 악교정 수술 후 안면신경 마비의 발생 유병율은 최근 0.1 퍼센트로 보고되고 있다. 증상 발생의 원인으로는 안면신경의 압박, 신경의 불완전 또는 완전 손상, 신경의 견인, 마취제에 의한 신경의 허혈 등이 있다. 술 후 발생된 안면 신경의 마비는 환자의 삶의 질을 저해하고 사회활동을 기피하게 함으로써 가장 심각한 합병증 중 하나라고 볼 수 있다. 본 증례에서는 양측 하악지 시상 골전달술을 시행 후 발생한 안면신경 마비에 대하여 보고하고 있다.

Keywords

References

  1. Kim SG, Park SS. Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg 2007;65(12):2438-2444. https://doi.org/10.1016/j.joms.2007.05.030
  2. Choi BK, Goh RC, Chen PK, Chuang DC, Lo LJ, Chen YR. Facial nerve palsy after sagittal split ramus osteotomy of the mandible: mechanism and outcomes. J Oral Maxillofac Surg 2010;68(7):1615-1621. https://doi.org/10.1016/j.joms.2010.01.010
  3. Dendy RA. Facial nerve paralysis following sagittal split mandibular osteotomy: A case report. Br J Oral Surg 1973;11(2):101-105. https://doi.org/10.1016/0007-117X(73)90024-3
  4. Cousin GC. Facial nerve palsy following intra-oral surgery performed with local anaesthesia. J R Coll Surg Edinb 2000;45(5):330-333.
  5. Ruiz LP, Lara JC. Facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible. Int J Oral Maxillofac Surg 2011;40 (8):884-886. https://doi.org/10.1016/j.ijom.2011.02.030
  6. Rai KK, Shivakumar HR, Sonar MD. Transient facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible: a review of incidence and management. J Oral Maxillofac Surg 2008;66(2):373-378. https://doi.org/10.1016/j.joms.2006.06.257
  7. de Santana Santos T, Albuquerque KM, Santos ME, Laureano Filho JR. Survey on complications of orthognathic surgery among oral and maxillofacial surgeons. J Craniofac Surg 2012;23(5):e423-430. https://doi.org/10.1097/SCS.0b013e31825e49c1
  8. de Vries K, Devriese PP, Hovinga J, van den Akker HP. Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies. J Craniomaxillofac Surg 1993;21(2):50-53. https://doi.org/10.1016/S1010-5182(05)80147-7
  9. Lanigan DT, Hohn FI. Facial nerve injuries after sagittal split mandibular ramus osteotomies for advancement: a report of 2 cases and review of the literature. J Oral Maxillofac Surg 2004;62(4):503-507. https://doi.org/10.1016/j.joms.2003.05.019
  10. Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951;74 (4):491-516. https://doi.org/10.1093/brain/74.4.491
  11. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146-147. https://doi.org/10.1177/019459988509300202
  12. Al-Bishri A, Dahlin L, Sunzel B, Rosenquist J. Systemic betamethasone accelerates functional recovery after a crush injury to the rat sciatic nerve. J Oral Maxillofac Surg 2005;63(7):973-977. https://doi.org/10.1016/j.joms.2004.10.010
  13. Kukkar A, Bali A, Singh N, Jaggi AS. Implications and mechanism of action of gabapentin in neuropathic pain. Arch Pharm Res 2013;36(3):237-251. https://doi.org/10.1007/s12272-013-0057-y
  14. Kusunose N, Koyanagi S, Hamamura K et al. Molecular basis for the dosing time-dependency of anti-allodynic effects of gabapentin in a mouse model of neuropathic pain. Mol Pain 2010;26;6:83.
  15. Jaggi AS, Singh N. Role of different brain areas in peripheral nerve injury-induced neuropathic pain. Brain Res 2011;24;1381:187-201.
  16. Davies A, Hendrich J, Van Minh AT, Wratten J, Douglas L, Dolphin AC. Functional biology of the alpha(2)delta subunits of voltage-gated calcium channels. Trends Pharmacol Sci 2007;28(5):220-228. https://doi.org/10.1016/j.tips.2007.03.005
  17. Scheller K, Scheller C. Nimodipine promotes regeneration of peripheral facial nerve function after traumatic injury following maxillofacial surgery: an off label pilot-study. J Craniomaxillofac Surg 2012;40(5):427-434. https://doi.org/10.1016/j.jcms.2011.07.016
  18. Jain Y, Falcioni M, Agarwal M, Taibah A, Sanna M. Total facial paralysis after vestibular schwannoma surgery: probability of regaining normal function. Ann Otol Rhinol Laryngol 2004;113(9):706-710. https://doi.org/10.1177/000348940411300906
  19. Jin SY, Kim SG, Kim HG et al. Facial nerve palsy after Bilateral Sagittal Split Ramus Osteotomy: Case report. J Korean Assoc Maxillofac Plast Reconstr Surg 2011;33(3):276-280.

Cited by

  1. A case of peripheral facial nerve palsy after orthognathic surgery in a patient with hemifacial microsomia vol.66, pp.10, 2013, https://doi.org/10.5794/jjoms.66.497