Efficacy of steroid treatment for sensory impairment after orthognathic surgery

doi:10.1016/j.joms.2004.06.033

Journal of Oral and Maxillofacial Surgery

Volume 62, Issue 10, October 2004, Pages 1193-1197

https://doi.org/10.1016/j.joms.2004.06.033 Get rights and content

Purpose

Steroid hormones are therapeutic for motor and/or sensory dysfunctions caused by nerve injury. However, the timing for giving such medicine is unclear. This study aimed to estimate the efficacy of steroid treatment and determine an appropriate start time after sensory impairment.

Patients and methods

Twenty-seven patients with sensory impairment who received orthognathic surgery were classified into groups called 1W (n = 6), 3W (n = 6), or 6W (n = 8) group on the basis of start time for steroid treatment, being 1 week, 3 weeks, or 6 weeks after surgery, respectively, and a no steroid treatment (NST) group (a control group) (n = 6) that did not receive treatment for 10 to 12 weeks after surgery. Sensory impairment was diagnosed if postoperative first week mechanical-touch threshold was over 4.0 as measured by Semmes aesthesiometer. Prednisolone treatment was administered orally to patients at 30 mg for 7 days, 15 mg for 4 days, and 5 mg for 3 days. Mechanical-touch threshold and thermal perceptions were compared before and after treatment.

Results

At 1 week postoperatively, there were no significant differences in mechanical-touch threshold among the 4 groups (analysis of variance, P > .05). Changes in mechanical-touch threshold in the 1W group showed no significant improvement (analysis of variance, P > .05), but in the 3W and 6W groups, there were significant differences compared with the NST group (Dunn’s methods, P < .05).

Conclusions

Steroid treatment for sensory impairment after orthognathic surgery has the potential to accelerate recovery and it appears desirable to start treatment later than 1 week postoperatively.

Section snippets

Patients and methods

This study was conducted according to the Declaration of Helsinki, informed consent was obtained from all subjects, and the Ethical Committee of Niigata University Dental Hospital approved the investigation.

More than 100 young, healthy patients who underwent sagittal split ramus osteotomy (SSRO) or intraoral ramus osteotomy (IVRO) were screened for any sensory impairment at chin sites between the lower vermilion border and the inferior mandible at postoperative 1 week. Patients who underwent

Patient backgrounds

Among the 4 groups, there were no significant differences in mean values of age, body height, or body weight (ANOVA, P > .05) (Table 1). There were no cases where the mandibular nerve appeared to have been cut during the operation, nor were there any complications (eg, bleeding or inflammation) that occurred during the postoperative period. One subject had some stomach discomfort during the 2 weeks of steroid administration, but no complications were observed in the other subjects.

Effects of steroid on mechanical-touch threshold

There was no

Discussion

Sensory impairments after mandibular sagittal split ramus and vertical ramus osteotomies are caused by direct and/or indirect damage to the inferior alveolar nerve,13, 14 and it has been reported that many patients show a complete recovery from the sensory deficit within 1 to 3 months.1, 15, 16 In cases of complete anesthesia after such surgery, microsurgical repair of severely damaged inferior nerves can produce some recovery.² In contrast, in cases of moderate sensory disturbance, natural

Acknowledgment

The authors wish to thank Dr John Zuniga for helpful insights.

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Received from the Division of Dental Anesthesiology, Department of Tissue Regeneration, and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Course for Oral Sciences, Niigata City, Japan.

This work was supported by Grants-in-Aid (14370665) for Scientific Research from the Japan Society for the Promotion of Science (JSPS).

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Clinical articlesEfficacy of steroid treatment for sensory impairment after orthognathic surgery

Purpose

Patients and methods

Results

Conclusions

Section snippets

Patients and methods

Patient backgrounds

Effects of steroid on mechanical-touch threshold

Discussion

Acknowledgment

Oral Maxillofac Surg Clin North Am

J Am Dent Assoc

Mol Brain Res

Neurosci Res

Neuroscience

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Surg

J Craniomaxillofax Surg

Br J Oral Maxillofac Surg

Clinical articles
Efficacy of steroid treatment for sensory impairment after orthognathic surgery