Development of a Unique Surgical Implant to Address the Development of Iatrogenic Trigeminal Neuralgia Following Maxillomandibular Advancement Surgery for OSA

Authors

• Erika L. Manning, Thomas Jefferson UniversityFollow
• Kun Yoon, Thomas Jefferson UniversityFollow
• Robert Diecidue, Thomas Jefferson UniversityFollow
• Joseph Harrington, Thomas Jefferson UniversityFollow

Document Type

Article

Publication Date

5-2-2026

Comments

This article is the author’s final published version in Oral and Maxillofacial Surgery Cases, Volume 12, Issue 2, 2026, Article number 100457.

The published version is available at https://doi.org/10.1016/j.omsc.2026.100457. Copyright © 2026 The Authors.

Abstract

A 58 y/o male with no significant past medical history presented in 2021 with obstructive sleep apnea (OSA), including trouble breathing through his nose due to hypoplastic maxilla, retrognathic mandible and chin, and microgenia. He underwent a LeFort 1 maxillary osteotomy, bilateral sagittal split osteotomy (BSSO), and genioplasty with fat graft on 2/10/2022. Postoperatively, the patient developed moderate pain and facial edema, which progressed into hypoesthesia with pain in the face with a sensation of fullness in the left ear and left masseter tightness. He also developed a positive Tinel sign in the left mandibular area and was diagnosed with trigeminal neuralgia (TN). In March 2024, a left inferior alveolar nerve (IAN) decompression was performed with removal of hardware and bone graft, but the patient reported increased pain with a burning sensation in his mouth. When rubbing the left inferior border of the mandible, the patient reported paresthesias on chin/lip. Gabapentin and steroids were attempted without benefit. MRI revealed that the IAN was exposed to overlying soft tissue of the neck angle area, with a vascular loop that contacted the superior aspect of the cisternal segment of the trigeminal nerve. On 11/11/2024, the patient underwent a second left IAN decompression, with a patient specific mandibular mesh/plate application to protect the exposed IAN. Following surgery, the patient reported that the nerve pain prior to surgery had improved, though he still reported a slight burning sensation of right lip/chin. The patient's symptoms continue to improve, and he follows up regularly for monitoring purposes.

Recommended Citation

Manning, Erika L.; Yoon, Kun; Diecidue, Robert; and Harrington, Joseph, "Development of a Unique Surgical Implant to Address the Development of Iatrogenic Trigeminal Neuralgia Following Maxillomandibular Advancement Surgery for OSA" (2026). Department of Oral and Maxillofacial Surgery Faculty Papers. Paper 10.
https://jdc.jefferson.edu/omsfp/10

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Language

English