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Effects of sagittal split osteotomy on brainstem reflexes

Auswirkungen einer sagittalen Spaltosteotomie auf Hirnstammreflexe

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objectives

This prospective study was designed to assess whether patients with skeletal deformities show characteristic masseter inhibitory reflex (MIR) and blink reflex (BR) patterns. A secondary aim was to investigate whether these reflexes change following bilateral sagittal split osteotomy (BSSO).

Materials and methods

Fourteen consecutive patients who underwent single-jaw BSSO and 14 class I subjects who constituted the control group were enrolled into the study. MIR and BR, obtained by the stimulation of supraorbital (SBR) and mental nerves (MBR), were electrophysiologically recorded. Sensory impairment in the mental nerve distribution was clinically tested. Three evaluation periods were specified as immediately before (T0), 1 month (T1) and 6 months (T2) after surgery.

Results

MIR early silent period duration was significantly shorter in the patients at T0 (p < 0.001). Sensory deficits developed on 23 sides after BSSO, of which, 17 recovered after 6 months. At T1, MBR was inelicitable bilaterally in 3 patients and unilaterally in 2 patients. These responses were still unrecordable bilaterally in 1 patient, and unilaterally in 4 patients at T2. MIR were unrecordable on 18 sides at T1 and recovered on 11 sides at T2. There were no parallels between the clinical sensory deficits and the abnormal results of the reflexes.

Conclusions

Shorter MIR in patients with dentofacial abnormalities may be a reflection of an adapted trigeminal reflex mechanism. Although MBR and MIR abnormalities do not develop parallel to the clinical sensory deficits, their course might provide insights into the disturbed trigeminal reflex pathways.

Zusammenfassung

Zielsetzungen

In dieser prospektiven Studie sollte untersucht werden, ob Patienten mit Skelettdeformitäten charakteristische Muster des inhibitorischen Masseterreflexes (MIR) und des Blinzelreflexes (BR) aufweisen. Ein weiteres Ziel war es, zu untersuchen, ob sich diese Reflexe nach einer bilateralen sagittalen Spaltosteotomie (BSSO) verändern.

Materialien und Methoden

Vierzehn konsekutiv aufgenommene Patienten, die sich einer monomaxillären BSSO unterzogen hatten, und 14 Klasse-I-Patienten, welche die Kontrollgruppe bildeten, wurden in die Studie aufgenommen. Der MIR sowie durch Stimulation des N. supraorbitalis (SBR) und des N. mentalis (MBR) getriggerte BR wurden elektrophysiologisch aufgezeichnet. Die sensorischen Beeinträchtigungen im Bereich des N. mentalis wurden klinisch untersucht. Drei Bewertungszeiträume wurden festgelegt: unmittelbar vor (T0), 1 Monat (T1) und 6 Monate (T2) nach der Operation.

Ergebnisse

Die Dauer der frühen, silenten Phase des MIR war bei den Patienten bei T0 signifikant kürzer (p < 0,001). Nach der BSSO entwickelten sich auf 23 Seiten sensorische Defizite, von denen sich 17 nach 6 Monaten erholten. Zum Zeitpunkt T1 war der MBR bei 3 Patienten beidseitig und bei 2 Patienten einseitig nicht auslösbar. Bei T2 waren diese Reaktionen bei einem Patienten bilateral und bei 4 Patienten unilateral nicht mehr nachzuweisen. Der MIR war bei T1 auf 18 Seiten nicht nachweisbar und bei T2 auf 11 Seiten wieder vorhanden. Es gab keine Parallelen zwischen den klinischen sensorischen Defiziten und den abnormalen Ergebnissen der Reflexe.

Schlussfolgerungen

Ein kürzerer MIR bei Patienten mit dentofazialen Anomalien kann Ausdruck eines angepassten Trigeminusreflexmechanismus sein. Auch wenn sich die MBR- und MIR-Anomalien nicht parallel zu den klinischen sensorischen Defiziten entwickeln, könnte ihr Verlauf Aufschluss über die gestörten trigeminalen Reflexbahnen geben.

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Acknowledgements

The authors wish to thank the individuals whose participation made this study possible.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Istanbul University, Istanbul, Turkey

    Aysenur Genc Ph.D D.D.S,  Sabri Cemil Isler Ph.D D.D.S &  Cengizhan Keskin Ph.D D.D.S

  2. Istanbul Medical Faculty, Department of Neurology, Istanbul University, Istanbul, Turkey

    Ali Emre Oge MD

  3. Faculty of Medicine, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey

    Zeliha Matur MD

Authors
  1. Aysenur Genc Ph.D D.D.S
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  2. Sabri Cemil Isler Ph.D D.D.S
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  3. Cengizhan Keskin Ph.D D.D.S
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  4. Ali Emre Oge MD
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  5. Zeliha Matur MD
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Correspondence to Aysenur Genc Ph.D D.D.S.

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Conflict of interest

A. Genc, S.C. Isler, C. Keskin, A.E. Oge and Z. Matur declare that they have no competing interests.

Ethical standards

The study conforms to the provisions of the Declaration of Helsinki (as revised in Tokyo in 2004) and had been approved by the Institutional Review Board for Human Studies of the Dentistry Faculty of the Istanbul University, Turkey (Study 2015/69). Consent for participation: Written informed consent was obtained from each participant. Consent for publication: Written informed consent was obtained.

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Supplementary Information

Supplemental Table S1.

The measured parameters of supraorbital and mental nerve blink reflex responses on the right and left sides. Supplemental Table S2. The measured parameters of masseter inhibitory reflex on the right and left sides

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Genc, A., Isler, S.C., Keskin, C. et al. Effects of sagittal split osteotomy on brainstem reflexes. J Orofac Orthop 84, 100–109 (2023). https://doi.org/10.1007/s00056-021-00350-x

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  • DOI: https://doi.org/10.1007/s00056-021-00350-x

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