Clinical comparision of hunsuck-epker and posnick osteotomy modifications on post operative neurosensorial disturbances after sagittal split ramus osteotomy

One of the major concerns regarding the low and short medial osteotomy technique is its potential neurosensory consequences. Unlike the classical understanding that the inferior alveolar nerve (IAN) should remain within the distal segment, this technique often results in partial retention of the IAN within the proximal segment. The aim of this study was to compare postoperative neurosensory disturbances between the Hunsuck-Epker modification and the "low and short medial osteotomy" modification of sagittal split ramus osteotomy. Patients aged between 18 and 35 with dentofacial deformities who applied to the Oral and Maxillofacial Surgery Clinic of Bezmialem Vakif University for orthognathic surgery were included in the study. A split-mouth randomized controlled trial design was used, in which the Hunsuck-Epker modification was performed on one side and the low and short medial osteotomy modification on the contralateral side. Double-blinded evaluations of neurosensory changes were conducted at 1, 3, and 6 months postoperatively. The assessments included painful stimuli, two-point discrimination, pressure, and brush stroke direction tests. Subjective neurosensory recovery was also evaluated using visual analog scale (VAS) scores provided by the patients. The results of the study indicated that there was no statistically significant difference in neurosensory recovery between the low and short medial osteotomy and the Hunsuck-Epker modification. The absence of a significant difference between the two surgical techniques compared in this study in terms of inferior alveolar nerve injury following orthognathic surgery has clarified uncertainties regarding the choice of surgical technique. This finding highlights the importance of considering not only the surgical method itself but also individual patient-related parameters, such as anatomical variations, during surgical planning