How is the inferior alveolar nerve avoided during orthognathic surgery?

[User28823]

Don't they gotta cut your jaw in half and advance it? But the inferior alveolar nerve is right in the middle of it isn't it? How do they avoid it?

i don't think i need mandible advancement fortunately, no issues with bite so genioplasty should be enough but just curious since i've been looking at all surgeries

my maxilla is asymmetric i think tho so if invisalign doesn't fix my crooked smile im finna get this shit, maybe fix all asymmetries

 

[Seilmaximierender]

They use piezo (sonic) cutters to crack your bone and it doesn't cause harm to any soft tissue. Just cracking the bone

 

[chemosh]

They dont avoid it. When they crack your bone the nerve will be in either the distal segment or the proximal segment.

Distal segment is good, chance of nerve damage arround 7%, very small manipulation probably needed.

Proximal segment is bad, they will have to pick the nerve from the mandible manipulate it and put in the other canal, chance of nerve damage arround 20-30%

Your nerve can be either close or far from the border of the mandible, the farthest it is the better the odds of being on the distal segment.

on average what makes it be on the proximal or distal segment when it breaks? God. When the surgeons hammers the chisel it will break some way. 0 control over how it does. If its a bad break your chances are even worse.

Usually the nerve is very close to the border of the mandible.

Class two patients tend to have a better nerve and are better prospects

Class three patients tend to have a nerve closer to the border while also having to compress the nerve on the canal, so increased risk for them.

Piezosonic has a average of 10% chance of noticeable nerve damage. It is actually more if measured objectivelly but the patient just gets used to it.

Common bur should be arround the same, the surgeon shouldnt get really close to the mandible canal since the break is done by chisel. But still there will always be a fuck up and piezo is better if that happens, while also preserving other tissues