Traumatic neuroma following sagittal split mandibular osteotomy

Traumatic neuroma following sagittal split osteotomy of the mandible

A 16-year-old male underwent bilateral sagittal split osteotomy of the mandible to correct a mandibular deficiency. Twenty-one years later, a routine panoramic radiograph revealed a radiolucent lesion on the left side of the mandible. The lesion was biopsied. As the patient did not have symptoms and the lesion was connected to the inferior alveolar nerve, the lesion was not totally excised in order to preserve nerve function. The histological features were consistent with traumatic neuroma, and no further surgical procedure was planned.

Atypical courses of the mandibular canal: comparative examination of dry mandibles and x-rays

Knowledge of the course of the mandibular canal and its anatomic variations is of great importance in oral surgery, especially in preprosthetic operations and the insertion of endosteal implants and during the planning of removable dentures prepared in cases involving extensively atrophied mandibles. We review the literature on duplicated mandibular canals, which is based exclusively on radiologic findings. Then, we compare this with an examination of dry mandibles and further radiologic studies. The incidence of duplicated mandibular canals observed in macroscopic examinations of mandibles was substantially higher than that revealed by radiographs. One case involving a novel variation, a triple mandibular canal, is reported.

Alteration in facial sensibility in adolescents following sagittal split and chin osteotomies of the mandible

Static two-point discrimination, pressure, and vibratory threshold values were measured bilaterally at standard coordinates in the area of the face innervated by the mental nerve in 115 adolescents (230 nerves). The patients were divided into four groups: normal adolescents who had not undergone any orthognathic surgery (group I controls, n = 134 nerves, mean age 18 years, SD = 3), those 1 year after undergoing bilateral sagittal split osteotomies of the mandible (group II, n = 14 nerves, mean age 19 years, SD = 2), those 1 year after undergoing an osteoplastic genioplasty (group III, n = 40, mean age 19 years, SD = 3), and those 1 year after undergoing a combination of bilateral sagittal split osteotomies and an osteoplastic genioplasty (group IV, n = 42 nerves, mean age 19 years, SD = 3). Subjective residual numbness at the 1 year postoperative interval was reported by 2 of 7 patients in group II, 2 of 20 patients in group III, and 14 of 21 patients (67 percent) in group IV. Long-term subjective numbness involved only the chin skin in 16 of 18 patients experiencing residual numbness and was perceived as problematic in the remaining 2 (group IV) patients whose subjective numbness also was measured objectively in the chin, lower lip (mucosa and skin), and gingiva. Objectively, the mean threshold values of the three sensory modalities tested were higher in group IV patients than in the remaining groups at all coordinates tested, but significant differences (p < 0.05) were found only between the mean two-point discrimination of group IV patients and the control group in the region of the chin skin. The high percentage of patients documented to have subjective and objective sensory disturbance after undergoing a combination of sagittal split osteotomies of the mandible and an osteoplastic genioplasty (group IV) may be explained by the "double crush syndrome."

Extraosseous and intraosseous oral traumatic neuromas and their association with tooth extraction

Tooth extraction has been suggested as the most common etiologic factor in the development of oral traumatic neuroma, but intraosseous lesions are stated to be rare. The clinicopathologic features of 45 oral traumatic neuromas are reviewed. Fifteen cases were painful. Inflammatory infiltrate was present in 53% of the painful cases in contrast to only 17% of asymptomatic neuromas, and was the only light microscopic feature significantly related to the incidence of pain. Eleven of 45 cases were found in an intraosseous location. Four of 45 reviewed neuromas were associated with extractions. All 4 cases were painful and 2 of them were in an intraosseous location. Only 3 of the 15 painful cases and 2 of the remaining asymptomatic 30 cases had a tentative clinical diagnosis of traumatic neuroma before removal.

Traumatic neuroma following sagittal mandibular osteotomy

A case of painful traumatic neuroma, arising from the inferior alveolar nerve after sagittal osteotomy of the mandible with demonstrable radiological change, is reported. The co-existence of temporomandibular joint (TMJ) pain-dysfunction syndrome and a painful traumatic neuroma had posed diagnostic problems. Some modifications of the surgical technique are discussed with a view to minimizing damage to the inferior alveolar nerve during sagittal osteotomy of the mandible. The aetiology, clinical features, diagnosis and treatment of traumatic neuromas are reviewed.