Piezosurgery-assisted transposition of the inferior alveolar nerve in a patient with osteoradionecrosis: A case report with a neurosensory assessment and a review of the literature

Osteoradionecrosis is one of the most severe complicating sequelae after head and neck radiotherapy. The mandible is commonly affected by osteoradionecrosis, and in cases of surgical intervention, preserving the inferior alveolar nerve (IAN) function is important for the patient's quality of life. Generally, precisely removing bone using conventional instruments such as rotating burs and oscillating saws is difficult in close vicinity to the neural structures. Furthermore, peripheral nerve injury and impairment of nerve regeneration occur in the irradiated region. The piezosurgery is an ultrasound instrument that can cut the bone without soft tissue damage. We herein report a 70-year-old male who underwent piezosurgery-assisted transposition of the IAN during mandibular sequestrectomy. The piezosurgery could precisely remove bone adjacent to the IAN, and transposition of the IAN could be performed successfully, even in the irradiated mandible. The objective neurosensory testing showed recovery of the nerve function at 2 weeks postoperatively; the duration of neurosensory disturbance was much shorter than conventional methods of reported cases. Our report emphasizes the beneficial effects of the piezosurgery in removing bone close to nerve structures and enlarges the indications in oral and maxillofacial surgery.