Completing sagittal split osteotomy of the mandible after fracture of the buccal plate

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Sagittal split ramus osteotomy is the most frequently used surgical procedure for correcting mandibular dysplasia. Nonetheless, despite this frequency of use, authors often describe the procedure as technically difficult. 1 Mehra P. Castro V. Freitas R.Z. et al. Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars. J Oral Maxillofac Surg. 2001; 59: 854 Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar , 2 Marquez I.M. Stella J.P. Modification of sagittal split ramus osteotomy to avoid unfavorable fracture around impacted third molars. Int J Adult Orthod Orthog Surg. 1998; 13: 183 PubMed Google Scholar , 3 O’Ryan F.S. Complications of orthognathic surgery. Oral Maxillofac Surg Clin North Am. 1990; 2: 593 Google Scholar One of the most common problems associated with the procedure is unfavorable fracture of either the proximal or distal segment: incidence rates as high as 18% have been reported for this type of fracture. 4 Guernsey L.H. DeChamplain R.W. Sequelae and complications of the intraoral sagittal osteotomy of the mandibular rami. Oral Surg Oral Med Oral Pathol. 1971; 32: 176 Abstract Full Text PDF PubMed Scopus (104) Google Scholar , 5 MacIntosh R.B. Experience with the sagittal osteotomy of the mandibular ramus A 13-year review. J Maxillofac Surg. 1981; 9: 151 Abstract Full Text PDF PubMed Scopus (187) Google Scholar , 6 Martis C.S. Complications after mandibular sagittal split osteotomy. J Oral Maxillofac Surg. 1984; 42: 101 Abstract Full Text PDF PubMed Scopus (144) Google Scholar , 7 Turvey T.A. Intraoperative complications of sagittal osteotomy of the mandibular ramus Incidence and management. J Oral Maxillofac Surg. 1985; 43: 504 Abstract Full Text PDF PubMed Scopus (102) Google Scholar , 8 Precious D.S. Lung K.E. Pynn B.R. et al. Presence of impacted teeth as a determining factor of unfavorable splits in 1256 sagittal-split osteotomies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 362 Abstract Full Text PDF PubMed Scopus (58) Google Scholar Several factors contributing to this type of fracture have been cited: presence of an impacted third molar, recent removal of a third molar, age of the patient, and extent of the surgeon’s experience. 3 O’Ryan F.S. Complications of orthognathic surgery. Oral Maxillofac Surg Clin North Am. 1990; 2: 593 Google Scholar In an analysis of 1,256 patients who underwent sagittal osteotomy, Precious et al 8 Precious D.S. Lung K.E. Pynn B.R. et al. Presence of impacted teeth as a determining factor of unfavorable splits in 1256 sagittal-split osteotomies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 362 Abstract Full Text PDF PubMed Scopus (58) Google Scholar found that fracture of the proximal segment was more common than fracture of the distal segment. Mehra et al 1 Mehra P. Castro V. Freitas R.Z. et al. Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars. J Oral Maxillofac Surg. 2001; 59: 854 Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar found that fracture of the distal segment occurred more often in younger patients with impacted third molars, whereas fracture of the proximal segment was seen more often in older patients without third molars. In a group of 70 patients, Reyneke et al 9 Reyneke J.P. Tsakiris P. Becker P. Age as a factor in the complication rate after removal of unerupted/impacted third molars at the time of mandibular sagittal split osteotomy. J Oral Maxillofac Surg. 2002; 60: 654 Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar found 3 fractures of the distal segment and 1 fracture of the proximal segment but did not describe treatment of these fractures.