Evaluation, prevention, and treatment of inferior alveolar nerve injury in bilateral sagittal split mandibular osteotomy.

BACKGROUND

Bilateral sagittal split osteotomy (BSSO) is a widely adopted surgical procedure for correcting mandibular deformities, yet neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) remains a significant postoperative complication. This complication adversely impacts patients' quality of life due to persistent sensory abnormalities in the lower lip and chin region.

MAIN BODY: This narrative review summarizes anatomical risks and prevention/management strategies. Cone-beam CT (CBCT) may clarify canal anatomy and support risk stratification. Nerve-sparing osteotomy modifications are intended to limit traction and direct exposure. Fixation choice may influence surrogate and early clinical outcomes; monocortical miniplates (MCF) may be associated with lower radiographic canal penetration and earlier recovery than bicortical screws (BCF), whereas long-term clinical differences are uncertain. Piezoelectric/ultrasonic devices may improve precision and reduce tissue trauma, and virtual planning with 3D-printed guides may support safer osteotomy paths. For established IAN injury, photobiomodulation (PBM) may support earlier recovery; corticosteroid effects are route-dependent-intravenous dexamethasone mainly reduces edema with uncertain NSD benefit, while local betamethasone at closure may yield early improvement.

CONCLUSION

Comprehensive management likely requires integrated preoperative assessment, refined technique, and postoperative adjuncts. Current evidence supports considering multimodal approaches-imaging-guided planning, nerve-sparing modifications, and PBM-to potentially reduce NSD and enhance early recovery, while standardized protocols and larger studies are needed before firm recommendations.