Abstract
The existence of cancellous bone between buccal and lingual cortical plates provides guidance for the desired split plane through the osteotomy lines and interruptions increase the risk of unfavorable fractures during sagittal split ramus osteotomy (SSRO). The aim of this study is to present a rare case of SSRO in the absence of cancellous bone concerning the osteotomy sites, a conservative approach using piezosurgery and bone separators to avoid complications.
Highlights
Sagittal split ramus osteotomy (SSRO) is the most common used technique to correct mandibular deformities
Unfavorable fractures mainly occur if the osteotomy placed in relatively thinner regions of ramus or where bone marrow space is interrupted between the internal and external cortical bone plates
The medial osteotomy should be perpendicular to the ascending ramus at the level of the superior part of the mandibular lingula (ML) and the posterior end of the osteotomy directed inferiorly a small degree which should be extended at least 3-6 mm posterior to the ML [3]
Summary
Sagittal split ramus osteotomy (SSRO) is the most common used technique to correct mandibular deformities. Dal Pont’s vertical osteotomy in the molar region, Hunsuck and Epker’s short lingual cut modifications are some of the best known [1]. It is a very successful and widely accepted method, various complications such as nerve injury, hemorrhage and unfavorable fractures known as bad split patterns can be seen [2]. Unfavorable fractures mainly occur if the osteotomy placed in relatively thinner regions of ramus or where bone marrow space is interrupted between the internal and external cortical bone plates. In rare cases with absence of bone marrow space, osteotomies have to be performed partially or very seldomly totally in cortical bone plate which increases the incidence dramatically
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