{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T04:10:15Z","timestamp":1777954215311,"version":"3.51.4"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Sagittal split ramus osteotomy (SSRO) is the most commonly performed mandibular procedure in orthognathic surgery. Although generally safe, neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) remains a frequent complication that can impair oral function and quality of life. This retrospective study included 463 patients who underwent SSRO, comprising 873 rami, at our department between 2014 and 2024. Patient- and ramus-level variables were extracted from electronic medical records, with postoperative NSD of the IAN defined as the primary outcome. We investigated the presence or absence of mandibular canal (MC)\u2013lateral cortical bone (LCB) contact on preoperative computed tomography, as well as the three types of lateral osteotomy line on postoperative panoramic radiographs. Descriptive statistics were used to summarize clinical characteristics, and the incidence of NSD was evaluated. Trends in annual NSD proportions were analyzed using a Cochran\u2013Armitage trend test, and univariable and multivariable logistic regression analyses were performed to assess associated factors. The incidence of NSD was 5.6% at the patient-level and 4.0% at the ramus-level. A decreasing trend in annual NSD incidence was observed (p\u2009&lt;\u20090.001). In multivariable analysis, the presence of MC\u2013LCB contact was strongly associated with NSD (odds ratio, 4.96; 95% confidence interval, 2.41\u201310.06; p\u2009&lt;\u20090.001). The incidence of NSD after SSRO was approximately 5% and showed a declining annual trend over time, possibly reflecting increasing surgical experience and improved instrumentation. MC\u2013LCB contact was associated with an approximately fivefold higher risk of NSD, highlighting the importance of careful and gentle osteotomy.<\/jats:p>","DOI":"10.1371\/journal.pone.0348209","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:29:11Z","timestamp":1777915751000},"page":"e0348209","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A retrospective review of sagittal split ramus osteotomy: Incidence and risk factors for neurosensory disturbance of the inferior alveolar nerve"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4051-1505","authenticated-orcid":true,"given":"Takuma","family":"Watanabe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Risa","family":"Okada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9546-9869","authenticated-orcid":true,"given":"Ryuji","family":"Uozumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michinobu","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Kawamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shizuko","family":"Fukuhara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makoto","family":"Hirota","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"issue":"7","key":"pone.0348209.ref001","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/S0030-4220(57)80063-2","article-title":"The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin","volume":"10","author":"R Trauner","year":"1957","journal-title":"Oral Surg Oral Med Oral Pathol"},{"issue":"1","key":"pone.0348209.ref002","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s40902-016-0068-y","article-title":"Recovery of inferior alveolar nerve injury after bilateral sagittal split ramus osteotomy (BSSRO): a retrospective study","volume":"38","author":"C-H Lee","year":"2016","journal-title":"Maxillofac Plast Reconstr Surg"},{"issue":"2","key":"pone.0348209.ref003","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jobcr.2015.04.006","article-title":"Neurosensory disturbance after bilateral sagittal split osteotomy: a retrospective study","volume":"5","author":"S Roychoudhury","year":"2015","journal-title":"J Oral Biol Craniofac Res"},{"issue":"11","key":"pone.0348209.ref004","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1053\/joms.2000.16621","article-title":"Factors affecting neurosensory disturbance after mandibular bilateral sagittal split osteotomy","volume":"58","author":"L Ylikontiola","year":"2000","journal-title":"J Oral Maxillofac Surg"},{"issue":"12","key":"pone.0348209.ref005","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1016\/j.joms.2004.04.021","article-title":"On neurosensory disturbance after sagittal split osteotomy","volume":"62","author":"A Al-Bishri","year":"2004","journal-title":"J Oral Maxillofac Surg"},{"key":"pone.0348209.ref006","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.jcms.2007.04.006","article-title":"Neurosensory disturbances one year after bilateral sagittal split mandibular ramus osteotomy performed with separators","volume":"35","author":"JPR van Merkesteyn","year":"2007","journal-title":"J Craniomaxillofac Surg"},{"issue":"8","key":"pone.0348209.ref007","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.jcms.2012.02.003","article-title":"Neurosensory disturbances one year after bilateral sagittal split osteotomy of the mandibula performed with separators: a multi-centre prospective study","volume":"40","author":"G Mensink","year":"2012","journal-title":"J Craniomaxillofac Surg"},{"issue":"7","key":"pone.0348209.ref008","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.ijom.2016.01.011","article-title":"Incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups: a retrospective study of 263 patients","volume":"45","author":"JP Verweij","year":"2016","journal-title":"Int J Oral Maxillofac Surg"},{"key":"pone.0348209.ref009","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.joms.2018.06.029","article-title":"Neurosensory disturbances after bilateral sagittal split osteotomy using piezoelectric surgery: a systematic review","volume":"77","author":"K Rude","year":"2019","journal-title":"J Oral Maxillofac Surg"},{"issue":"1","key":"pone.0348209.ref010","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/0278-2391(90)90190-D","article-title":"The mandibular inferior border split: a modification in the sagittal split osteotomy","volume":"48","author":"LM Wolford","year":"1990","journal-title":"J Oral Maxillofac Surg"},{"issue":"6","key":"pone.0348209.ref011","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S0266-4356(98)90458-2","article-title":"Inferior alveolar nerve function after sagittal split osteotomy of the mandible: correlation with degree of intraoperative nerve encounter and other variables in 496 operations","volume":"36","author":"A Westermark","year":"1998","journal-title":"Br J Oral Maxillofac Surg"},{"issue":"3","key":"pone.0348209.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0091055","article-title":"Risk factors of neurosensory disturbance following orthognathic surgery","volume":"9","author":"AB Alolayan","year":"2014","journal-title":"PLoS One"},{"issue":"4","key":"pone.0348209.ref013","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1097\/SCS.0b013e3181e1b5ff","article-title":"Complications of orthognathic surgery: the inferior alveolar nerve","volume":"21","author":"A D\u2019Agostino","year":"2010","journal-title":"J Craniofac Surg"},{"issue":"5","key":"pone.0348209.ref014","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1037\/0003-066X.55.5.469","article-title":"Emerging adulthood. A theory of development from the late teens through the twenties","volume":"55","author":"JJ Arnett","year":"2000","journal-title":"Am Psychol"},{"issue":"5","key":"pone.0348209.ref015","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1136\/jech-2022-219674","article-title":"Socioeconomic position at the age of 30 and the later risk of a mental disorder: a nationwide population-based register study","volume":"77","author":"C Hakulinen","year":"2023","journal-title":"J Epidemiol Community Health"},{"issue":"3","key":"pone.0348209.ref016","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.ijom.2004.06.001","article-title":"Computed tomographic analysis of the position and course of the mandibular canal: relevance to the sagittal split ramus osteotomy","volume":"34","author":"Y Tsuji","year":"2005","journal-title":"Int J Oral Maxillofac Surg"},{"key":"pone.0348209.ref017","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1746-160X-6-4","article-title":"Three lateral osteotomy designs for bilateral sagittal split osteotomy: biomechanical evaluation with three-dimensional finite element analysis","volume":"6","author":"H Takahashi","year":"2010","journal-title":"Head Face Med"},{"issue":"6","key":"pone.0348209.ref018","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1016\/j.oooo.2022.04.002","article-title":"Risk factors of neurosensory disturbances at 1 year postoperatively after bilateral sagittal split osteotomy","volume":"134","author":"M Shibata","year":"2022","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"issue":"9","key":"pone.0348209.ref019","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1016\/j.joms.2007.05.009","article-title":"Neurosensory disturbance of the inferior alveolar nerve after bilateral sagittal split osteotomy: a systematic review","volume":"65","author":"G Colella","year":"2007","journal-title":"J Oral Maxillofac Surg"},{"issue":"7","key":"pone.0348209.ref020","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.ijom.2007.02.006","article-title":"Facial altered sensation and sensory impairment after orthognathic surgery","volume":"36","author":"GK Essick","year":"2007","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"5","key":"pone.0348209.ref021","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.joms.2006.01.009","article-title":"Neurosensory alteration in the lower lip and chin area after orthognathic surgery: bilateral sagittal split osteotomy versus inverted L ramus osteotomy","volume":"64","author":"A Kobayashi","year":"2006","journal-title":"J Oral Maxillofac Surg"},{"issue":"5","key":"pone.0348209.ref022","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1053\/joms.2002.31843","article-title":"Relationship of the mandibular canal to the lateral cortex of the mandibular ramus as a factor in the development of neurosensory disturbance after bilateral sagittal split osteotomy","volume":"60","author":"R Yamamoto","year":"2002","journal-title":"J Oral Maxillofac Surg"},{"issue":"6","key":"pone.0348209.ref023","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1067\/moe.2002.122639","article-title":"Comparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy","volume":"93","author":"L Ylikontiola","year":"2002","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"12","key":"pone.0348209.ref024","doi-asserted-by":"crossref","first-page":"3022","DOI":"10.1016\/j.joms.2009.09.046","article-title":"Relationship between inferior alveolar nerve canal position at mandibular second molar in patients with prognathism and possible occurrence of neurosensory disturbance after sagittal split ramus osteotomy","volume":"68","author":"I Yoshioka","year":"2010","journal-title":"J Oral Maxillofac Surg"},{"issue":"2","key":"pone.0348209.ref025","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.joms.2011.01.040","article-title":"Risk factors for neurosensory disturbance after bilateral sagittal split osteotomy based on position of mandibular canal and morphology of mandibular angle","volume":"70","author":"K Yamauchi","year":"2012","journal-title":"J Oral Maxillofac Surg"},{"issue":"4","key":"pone.0348209.ref026","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.oooo.2020.05.008","article-title":"The relationship between neurosensory disturbance of the inferior alveolar nerve and the lingual split pattern after sagittal split osteotomy","volume":"130","author":"G Martinez-de la Cruz","year":"2020","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"issue":"5","key":"pone.0348209.ref027","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1016\/j.ijom.2019.09.003","article-title":"Patterns of lingual split and lateral bone cut end and their associations with neurosensory disturbance after bilateral sagittal split osteotomy","volume":"49","author":"J Hu","year":"2020","journal-title":"Int J Oral Maxillofac Surg"},{"issue":"1","key":"pone.0348209.ref028","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s12663-022-01792-5","article-title":"Anatomical analysis of inferior alveolar nerve relation to mandibular posterior teeth using cone beam computed tomography: a retrospective radiographic analysis study","volume":"23","author":"YN El Hadidi","year":"2024","journal-title":"J Maxillofac Oral Surg"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348209","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:29:15Z","timestamp":1777915755000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348209"}},"subtitle":[],"editor":[{"given":"Paolo","family":"Boffano","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0348209","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]}}}