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

국문 초록 (Abstract)

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.

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 진수영, "양측 하악지 시상골 절단술 후 발생한 안면 신경 마비의 증례" 대한악안면성형재건외과학회 33 (33): 276-280, 2011

2 Rai KK, "Transient facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible: a review of incidence and management" 66 (66): 373-378, 2008

3 Jain Y, "Total facial paralysis after vestibular schwannoma surgery: probability of regaining normal function" 113 (113): 706-710, 2004

4 Al-Bishri A, "Systemic betamethasone accelerates functional recovery after a crush injury to the rat sciatic nerve" 63 (63): 973-977, 2005

5 de Santana Santos T, "Survey on complications of orthognathic surgery among oral and maxillofacial surgeons" 23 (23): e423-e430, 2012

6 Jaggi AS, "Role of different brain areas in peripheral nerve injury-induced neuropathic pain" 24 (24): 187-201, 2011

7 Scheller K, "Nimodipine promotes regeneration of peripheral facial nerve function after traumatic injury following maxillofacial surgery: an off label pilot-study" 40 (40): 427-434, 2012

8 Kusunose N, "Molecular basis for the dosing time-dependency of anti-allodynic effects of gabapentin in a mouse model of neuropathic pain" 26 : 6-83, 2010

9 Kim SG, "Incidence of complications and problems related to orthognathic surgery" 65 (65): 2438-2444, 2007

10 Ankesh Kukkar, "Implications and mechanism of action of gabapentin in neuropathic pain" 대한약학회 36 (36): 237-251, 2013

11 Davies A, "Functional biology of the alpha(2)delta subunits of voltage-gated calcium channels" 28 (28): 220-228, 2007

12 de Vries K, "Facial palsy after sagittal split osteotomies. A survey of 1747 sagittal split osteotomies" 21 (21): 50-53, 1993

13 Dendy RA, "Facial nerve paralysis following sagittal split mandibular osteotomy: A case report" 11 (11): 101-105, 1973

14 Cousin GC, "Facial nerve palsy following intra-oral surgery performed with local anaesthesia" 45 (45): 330-333, 2000

15 Ruiz LP, "Facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible" 40 (40): 884-886, 2011

16 Choi BK, "Facial nerve palsy after sagittal split ramus osteotomy of the mandible: mechanism and outcomes" 68 (68): 1615-1621, 2010

17 Lanigan DT, "Facial nerve injuries after sagittal split mandibular ramus osteotomies for advancement: a report of 2 cases and review of the literature" 62 (62): 503-507, 2004

18 House JW, "Brackmann DE. Facial nerve grading system" 93 : 146-147, 1985

19 Sunderland S, "A classification of peripheral nerve injuries producing loss of function" 74 (74): 491-516, 1951