A comparison of questionnaire versus monofilament assessment of neurosensory deficit

• Published in: Journal of oral and maxillofacial surgery Vol. 54; no. 4; p. 454
• Main Authors: Cunningham, L L, Tiner, B D, Clark, G M, Bays, R A, Keeling, S D, Rugh, J D
• Format: Journal Article
• Language: English
• Published: United States 01-04-1996
• Subjects: Adolescent; Adult; Chin - innervation; Female; Humans; Male; Malocclusion, Angle Class II - surgery; Mandible - surgery; Middle Aged; Neurologic Examination; Osteotomy - adverse effects; Paresthesia - diagnosis; Paresthesia - etiology; Paresthesia - psychology; Patients - psychology; Reproducibility of Results; Sensitivity and Specificity; Statistics, Nonparametric; Surveys and Questionnaires
• ISSN: 0278-2391
• DOI: 10.1016/S0278-2391(96)90120-2

Because neurosensory deficit is commonly reported by patients after orthognathic surgery, it is important to know how accurately patients can report their own sensory deficit. This analysis compares the results of objective neurosensory tests with the results of a subjective patient questionnaire.
Before and 6 months after bilateral mandibular sagittal ramus split osteotomy, 101 patients with class II facial deformities were asked to rate sensations of numbness or tingling in the area of the mental nerve. Simultaneously, they were objectively tested using monofilament neurosensory tests (light touch and brush stroke direction).
More than 70% of patients subjectively reported neurosensory problems, but objective assessment identified neurosensory deficits in less than 60% of the patients. The sensitivity and specificity of the patients' subjective assessments were 75.3% and 52.8%, respectively, for the light touch test, and 77.9% and 59.8%, respectively, for the brush stroke test.
It was concluded that when monofilament neurosensory testing is used as the gold standard, patients appear to overreport neurosensory problems; ie, the positive predictive value of patient reports is only 63.2%, resulting in frequent false positives.