Orthognathic surgery-related nerve injuries: analysis and treatment modalities

Background: Orthognathic surgery, while highly effective in correcting dentofacial deformities, inherently poses a risk of neurosensory complications. Despite the growing volume of these surgical procedures, real-world data remain limited concerning the precise incidence, clinical course, and efficacy of various therapeutic interventions for nerve injuries in this specific context. This study aims to delineate the incidence, anatomical distribution, and treatment outcomes of trigeminal nerve injuries observed after orthognathic surgery within a tertiary care center. Methods: This retrospective cohort study involved 287 patients who underwent orthognathic surgical procedures. Data, including demographic, surgical, and follow-up course, were extracted from electronic medical records. Nerve injuries were specifically identified based on documented postoperative sensory complaints localized to the distribution of the maxillary (CN V2) or mandibular (CN V3) divisions of the trigeminal nerve. Data regarding post-operative treatment using different modalities were collected and analyzed. Results: Our retrospective review identified 17 nerve injuries based on documented postoperative sensory complaints within the CN V2 or CN V3 distributions. The various treatment modalities employed included low-level laser therapy (LLLT), corticosteroids, and vitamin B supplementation. Detailed outcomes regarding the incidence and distribution of these injuries were analyzed. Conclusions: Post-orthognathic surgery trigeminal neurosensory deficits, while not common, are clinically significant. Our findings suggest that LLLT may offer a therapeutic advantage in managing these deficits, though achieving complete neurosensory recovery remains a challenge.

Inferior alveolar nerve; Low-level laser therapy; Neurosensory deficit; Orthognathic surgery; Trigeminal nerve injury; Vitamin B supplementation

[1] Panula K, Finne K, Oikarinen K. Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. Journal of Oral and Maxillofacial Surgery. 2001; 59: 1128–1136; discussion 1137.

[2] Jędrzejewski M, Smektała T, Sporniak-Tutak K, Olszewski R. Preoperative, intraoperative, and postoperative complications in orthognathic surgery: a systematic review. Clinical Oral Investigations. 2015; 19: 969–977.

[3] Kim SG, Park SS. Incidence of complications and problems related to orthognathic surgery. Journal of Oral and Maxillofacial Surgery. 2007; 65: 2438–2444.

[4] Kim YK. Complications associated with orthognathic surgery. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2017; 43: 3–15.

[5] Logvynenko I, Bursova V. Inferior alveolar nerve injury after sagittal split osteotomy of the mandible: a literature review. Chinese Journal of Plastic and Reconstructive Surgery. 2024; 6: 219–227.

[6] D’Agostino A, Trevisiol L, Gugole F, Bondí V, Nocini PF. Complications of orthognathic surgery: the inferior alveolar nerve. Journal of Craniofacial Surgery. 2010; 21: 1189–1195.

[7] Peleg O, Mahmoud R, Shuster A, Arbel S, Manor Y, Ianculovici C, et al. Orthognathic surgery complications: the 10-year experience of a single center. Journal of Cranio-Maxillofacial Surgery. 2021; 49: 891–897.

[8] Chow LK, Singh B, Chiu WK, Samman N. Prevalence of postoperative complications after orthognathic surgery: a 15-year review. Journal of Oral and Maxillofacial Surgery. 2007; 65: 984–992.

[9] Nguyen JD, Duong H. Anatomy, head and neck: alveolar nerve. StatPearls Publishing: Treasure Island (FL). 2025.

[10] Morris DE, Lo LJ, Margulis A. Pitfalls in orthognathic surgery: avoidance and management of complications. Clinics in Plastic Surgery. 2007; 34: e17–e29.

[11] Kwon G, Hohman MH. Inferior alveolar nerve and lingual nerve injury. StatPearls Publishing: Treasure Island (FL). 2025.

[12] Kotaniemi KVM, Suojanen J, Palotie T. Peri- and postoperative complications in Le Fort I osteotomies. Journal of Cranio-Maxillofacial Surgery. 2021; 49: 789–798.

[13] Alolayan AB, Alzahrani S. Optimizing outcomes: strategies for the prevention and management of neurosensory disturbances in orthognathic surgery. Current Problems in Surgery. 2024; 61: 101643.

[14] Zhao HR, Zhao N, Xu YX, Wang FC, Xiao WL. Evaluation, prevention, and treatment of inferior alveolar nerve injury in bilateral sagittal split mandibular osteotomy. Maxillofacial Plastic and Reconstructive Surgery. 2025; 47: 31.

[15] Leung YY, Wang R, Wong NSM, Li DTS, Au SW, Choi WS, et al. Surgical morbidities of sagittal split ramus osteotomy versus intraoral vertical ramus osteotomy for the correction of mandibular prognathism: a randomized clinical trial. International Journal of Oral & Maxillofacial Surgery. 2021; 50: 933–939.

[16] Roychoudhury S, Nagori SA, Roychoudhury A. Neurosensory disturbance after bilateral sagittal split osteotomy: a retrospective study. Journal of Oral Biology and Craniofacial Research. 2015; 5: 65–68.

[17] Bertagna EA, Van der Cruyssen F, Miloro M. Persistent neurosensory disturbance following sagittal split osteotomy: a systematic review and meta-analysis of one-year outcomes and risk factors. Journal of Oral and Maxillofacial Surgery. 2026; 84: 25–44.

[18] Vyloppilli S, Thangavelu A, Vichattu SV, Kumar N, Ahmad F, Sayd S. Incidence of inferior alveolar nerve sensory deficit and intra-operative nerve encounters after advancement of retrognathic mandible—a cross-sectional survey study. Indian Journal of Dental Research. 2022; 33: 116–119.

[19] Agbaje JO, Salem AS, Lambrichts I, Jacobs R, Politis C. Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances. International Journal of Oral and Maxillofacial Surgery. 2015; 44: 447–451.

[20] Verweij JP, Houppermans PN, Gooris P, Mensink G, van Merkesteyn JP. Risk factors for common complications associated with bilateral sagittal split osteotomy: a literature review and meta-analysis. Journal of Cranio-Maxillofacial Surgery. 2016; 44: 1170–1180.

[21] Dobriyan A, Akerman E, Yoffe T, Blinder D, Tessler I, Gecel NA, et al. Impact and stability of mandibular setback after intraoral vertical ramus osteotomy. Applied Sciences. 2022; 12: 12234.

[22] Hamad SA, Khrwatany KAK, Mohammed MR, Tutmayi SH. Effect of betamethasone injection into the pterygomandibular space on the neurosensory disturbance after bilateral sagittal split ramus osteotomy: a pilot study. European Journal of Medical Research. 2024; 29: 96.

[23] Hanfesh A, Salma RG, Al Mutairi K, AlShiha SK, Al Otaibi S. The neurosensory deficit of inferior alveolar nerve following bilateral sagittal split osteotomy: a prospective study. Oral and Maxillofacial Surgery. 2022; 26: 401–415.

[24] Schlund M, Grall P, Ferri J, Nicot R. Effect of modified bilateral sagittal split osteotomy on inferior alveolar nerve neurosensory disturbance. British Journal of Oral and Maxillofacial Surgery. 2022; 60: 1086–1091.

[25] Alharbi G, Rao JKD, Alnaim T, Alzamil N, Nagarajappa R. Efficacy of low-level laser therapy and microsurgery on neurosensory recovery following inferior alveolar and lingual nerve injuries: a systematic review. Journal of Oral Biology and Craniofacial Research. 2024; 14: 631–637.

[26] Arany PR. Photobiomodulation therapy. JADA Foundational Science. 2025; 4: 100045.

[27] Olszewska A, Wolny M, Kensy J, Kotela A, Czajka-Jakubowska A, Matys J. Photobiomodulation therapy for neurosensory disturbances in orthognathic surgery patients: a systematic review. Life. 2025; 15: 111.

[28] Passos RM, Pimentel KF, de Barros Silva PG, Sousa FB, Costa FWG, Cetira Filho EL. Effectiveness of low-intensity laser photobiomodulation in reducing inflammatory events (pain, edema, and trismus) after orthognathic surgery: a systematic review and meta-analysis of randomized clinical trials. Clinical Oral Investigations. 2023; 27: 5771–5792.

[29] Santos FT, Sciescia R, Santos PL, Weckwerth V, Dela Coleta Pizzol KE, Queiroz TP. Is low-level laser therapy effective on sensorineural recovery after bilateral sagittal split osteotomy? Randomized trial. Journal of Oral and Maxillofacial Surgery. 2019; 77: 164–173.

[30] Sharifi R, Fekrazad R, Taheri MM, Kasaeian A, Babaei A. Effect of photobiomodulation on recovery from neurosensory disturbances after sagittal split ramus osteotomy: a triple-blind randomised controlled trial. British Journal of Oral and Maxillofacial Surgery. 2020; 58: 535–541.

[31] Nasiri M, Ghannadpour A, Hakimiha N. Efficacy of blood products and photobiomodulation therapy for neurosensory recovery in patients with inferior alveolar nerve injury following orthognathic surgery: a systematic review study. Journal of Lasers in Medical Sciences. 2025; 16: e5.

[32] Mrowicka M, Mrowicki J, Dragan G, Majsterek I. The importance of thiamine (vitamin B1) in humans. Bioscience Reports. 2023; 43: BSR20230374.

[33] Cuyubamba O, Braga CP, Swift D, Stickney JT, Viel C. The combination of neurotropic vitamins B1, B6, and B12 enhances neural cell maturation and connectivity superior to single B vitamins. Cells. 2025; 14: 477.

[34] Rayner MLD, Ruiz AJ, Viel C. The combination of neurotropic B vitamins (B1, B6, and B12) is superior to individual B vitamins in promoting neurite growth in vitro. In Vitro Cellular & Developmental Biology—Animal. 2025; 61: 264–267.

[35] Kopruszinski CM, Reis RC, Chichorro JG. B vitamins relieve neuropathic pain behaviors induced by infraorbital nerve constriction in rats. Life Sciences. 2012; 91: 1187–1195.

[36] Okada K, Tanaka H, Temporin K, Okamoto M, Kuroda Y, Moritomo H, et al. Methylcobalamin increases Erk1/2 and Akt activities through the methylation cycle and promotes nerve regeneration in a rat sciatic nerve injury model. Experimental Neurology. 2010; 222: 191–203.

[37] Qi W, Wang Y, Huang YY, Jiang Y, Yuan L, Lyu P, et al. Photobiomodulation therapy for management of inferior alveolar nerve injury post-extraction of impacted lower third molars. Lasers in Dental Science. 2020; 4: 25–32.

[38] Ramamoorthy S, Cidlowski JA. Corticosteroids: mechanisms of action in health and disease. Rheumatic Disease Clinics of North America. 2016; 42: 15–31, vii.

[39] Al-Bishri A, Rosenquist J, Sunzel B. On neurosensory disturbance after sagittal split osteotomy. Journal of Oral and Maxillofacial Surgery. 2004; 62: 1472–1476.

[40] Bravo M, Bendersky Kohan J, Uribe Monasterio M. Effectiveness of glucocorticoids in orthognathic surgery: an overview of systematic reviews. British Journal of Oral and Maxillofacial Surgery. 2022; 60: e231–e245.