J Korean Assoc Oral Maxillofac Surg.  2017 Oct;43(5):318-323. 10.5125/jkaoms.2017.43.5.318.

Inferior alveolar nerve cutting; legal liability versus desired patient outcomes

• Kim SM
• Lee JH

• KMID: 2393597
• DOI: http://doi.org/10.5125/jkaoms.2017.43.5.318

Abstract

OBJECTIVES
Mandibular angle reduction or reduction genioplasty is a routine well-known facial contouring surgery that reduces the width of the lower face resulting in an oval shaped face. During the intraoral resection of the mandibular angle or chin using an oscillating saw, unexpected peripheral nerve damage including inferior alveolar nerve (IAN) damage could occur. This study analyzed cases of damaged IANs during facial contouring surgery, and asked what the basic standard of care in these medical litigation-involved cases should be.
MATERIALS AND METHODS
We retrospectively reviewed a total of 28 patients with IAN damage after mandibular contouring from August 2008 to July 2015. Most of the patients did not have an antipathy to medical staff because they wanted their faces to be ovoid shaped. We summarized three representative cases according to each patient's perceptions and different operation procedures under the approvement by the Institutional Review Board of Seoul National University.
RESULTS
Most of the patients did not want to receive any further operations not due to fear of an operation but because of the changes in their facial appearance. Thus, their fear may be due to a desire for a better perfect outcome, and to avoid unsolicited patient complaints related litigation.
CONCLUSION
This article analyzed representative IAN cutting cases that occurred during mandibular contouring esthetic surgery and evaluated a questionnaire on the standard of care for the desired patient outcomes and the specialized surgeon's position with respect to legal liability.

Keyword

Facial contouring surgery; Legal liability; Less-than-perfect outcome of beauty; Unsolicited patient complaints; Medical malpractice

MeSH Terms

Chin
Ethics Committees, Research
Genioplasty
Humans
Jurisprudence
Liability, Legal*
Mandibular Nerve*
Medical Staff
Peripheral Nerves
Retrospective Studies
Seoul
Standard of Care
Surgery, Plastic

Figure

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  Fig. 1 Panoramic view of Case 1 showing inferior alveolar nerve cutting (white arrows).

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  Fig. 2 Panoramic view of Case 2 showing a right inferior alveolar nerve cutting (white arrows) and two horizontal osteotomy lines after genioplasty.

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  Fig. 3 Comparative preoperative and postoperative panoramic views of Case 3 showing an inferior alveolar nerve (IAN) cutting on both sides (A; white arrows) and slight continuations of both IANs (B; white arrows) after foreign body removals with decompression surgery.

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