Major clinical approaches to osteotomy of the middle third face: a concise systematic review

Abstract

Introduction: Orthognathic surgery is a standardized procedure used to improve the patient's facial appearance and to correct maxillary and mandibular deformities resulting from malocclusion, disease, or trauma. Non-ossification between the maxillary bones after osteotomies is an important complication that may occur after performing this surgical procedure. Objective: It was to evaluate and quantify the three-dimensional space between the mandibular bone segments after advances in bilateral sagittal osteotomies of the mandible, involving the middle third of the face, with a consequent indication of bone grafting to achieve better surgical results, in terms of bone healing, stability, complications and prevention of aesthetic defects. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from February to April 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 104 articles were found, 28 articles were evaluated and 22 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 46 studies with a high risk of bias and 20 studies that did not meet GRADE. Bilateral sagittal osteotomy involving the middle third of the face is the most used technique in mandibular orthognathic surgery, allowing mandibular movements in the sagittal, vertical, and transverse directions, with good results and few complications. Also, in orthognathic surgeries, bone grafting can accelerate bone formation.