Uncovering the Evolution of the Bilateral Sagittal Split Osteotomy: A Journey Through Time

Comparative Evaluation of Vertical Body Osteotomy and Sagittal Split Osteotomy for Mandibular Corpus Distraction: Is There a Rationale for the New Technique?

A modified mandibular ramus osteotomy for orthognathic surgery

Residents' journal review

Introduction: Mandibular prognathism is a common dentofacial deformity that is often treated with orthognathic surgery (jaw straightening or corrective jaw surgery). The two most common types of operations to correct mandibular prognathism are the mandibular bilateral sagittal split osteotomy (BSSO) and/or the intraoral vertical ramus osteotomy (IVRO). Although there are other surgeries that exist to correct this type of deformity, the BSSO and IVRO are the most commonly used treatment options. The advantages and disadvantages to each of these procedures are generally well documented in the literature. However, facial nerve palsy is an infrequent and less commonly reported complication of these two types of surgeries. We provide a case report of one such instance of total unilateral facial nerve palsy following mandibular BSSO. Materials and Methods: A 20-year-old man with mandibular prognathism underwent mandibular setback surgery via a bilateral mandibular sagittal split osteotomy. His surgery was complicated by a right-sided mandibular buccal plate fracture intraoperatively and a severe unilateral right-sided cranial nerve VII palsy postoperatively. Results: While still admitted to the hospital, the patient was noted to have a right-sided palsy of all branches of the facial nerve. This facial nerve palsy continued to persist on an outpatient basis, although the patient ultimately had full resolution of his right-sided facial nerve palsy at 10 months postoperatively. Conclusions: The complication of facial nerve palsy may be devastating to a patient, especially when the procedure is deemed elective. Although the exact mechanism is unknown, facial nerve palsy secondary to mandibular surgery is most likely related to the close proximity of the field of operation to the anatomy of the facial nerve. This assumption is supported by the lack of documented cases of facial nerve palsy from maxillary orthognathic surgery. Although rare, the authors feel that the risk of facial nerve injury should be discussed with the patient when mandibular surgery is planned.

Postoperative stability of the hybrid method of rigid internal fixation in sagittal split osteotomy for orthognathic surgery: A systematic review.

PurposeTo retrospectively compare the high-angled sagittal split osteotomy (HOO) and the bilateral sagittal split osteotomy (BSSO) for the correction of skeletal dysgnathias regarding intra- and postoperative complications.MethodsThe electronic medical records of all patients treated with an orthognathic surgery at the Department for Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Germany, between the years 2009 and 2019 were retrospectively reviewed.ResultsTwo hundred ninety-one patients were included. The overall complication rates were 19.78% (BSSO) compared to 12.5% (HOO) (p = 0.14). Significant differences were found regarding the operation time (HOO < BSSO, p = 0.02), material failure (HOO > BSSO, p = 0.04), and early recurrence requiring revision surgery (HOO < BSSO, p = 0.002). The use of a ramus plate significantly reduced the risk of plate failure (2.8% < 13.6%, p = 0.05). More bad splits (p = 0.08) and early sensory disorders (p = 0.07) occurred in the BSSO group.ConclusionThe HOO presents a possible alternative to the BSSO since newly developed osteosynthesis material significantly reduces the risk of material failure. The BSSO is accompanied by higher risks of developing complications like a bad split and sensory disorders but, however, remains the standard for large anterior–posterior transpositions of the mandible.

Introduction: Laterognathia is characterized by the mandibular deviation to one of the sides affected which often caused by unilateral overgrowth of the mandible and age-related adaptive remodeling changes in the temporomandibular joint (TMJ) that affected masticatory function and aesthetics. The aim of this serial case report is to discuss the surgical management for laterognathia with bilateral sagittal split osteotomy (BSSO) on a clinical case of asymmetrical dentofacial deformity due to an excessive mandibular unilateral laterognathia. Case Report: This case report contains two cases of mandibular laterognathia. Both of our patients underwent a corrective procedure with bilateral sagittal split ramus osteotomy (BSSO) that performed mandibular setback and rotation. Post-operative follow-up showed the patient was in good condition and no complications were noted. Conclusion: The mandibular setback and rotation procedure can be performed with a bilateral sagittal split ramus osteotomy (BSSO). Significant improvement of laterognathia in occlusion, masticatory function, and facial appearance was achieved by surgical management with BSSO procedure. Keywords: laterognathia, bilateral sagittal split osteotomy, mandibular setback.

Are bicortical screw and plate osteosynthesis techniques equal in providing skeletal stability with the bilateral sagittal split osteotomy when used for mandibular advancement surgery? A systematic review and meta-analysis

This study was aimed to investigate a modified buccal osteotomy technique and whether the integrity of the lingual part of the lower border influences the attachment of the neurovascular bundle to the proximal segment of the mandible during a sagittal split osteotomy without increasing the number of bad splits. The presence of self-reported sensibility disturbance in the lower lip at the last follow-up visit was assessed. This study included 220 and 133 patients with bilateral sagittal split osteotomy undergoing the classical and the new modified buccal osteotomy techniques, respectively. In the new technique, the lower border is divided into a lingual fragment that remains incorporated in the tooth-bearing fragment and a buccal fragment that comes with the proximal fragment (buccal plate). In the classical technique, the inferior alveolar nerve was attached to the proximal segment of the mandible in more than one third of operation sites (36.36% on the right and 40.91% on the left) compared with less than one fourth of the operation sites using the new technique (9.73% on the right and 23.01% on the left). The overall figure of self-reported changed sensibility was 09.40% (12/128) in the new technique compared to 15.12% in the classical technique. We present a suitable improvement to the classical buccal osteotomy technique that allows less manipulation and injury of the inferior alveolar nerve with consequent reduction in self-reported postoperative changes in lower lip sensation

Influence of Osteotomy Design on Bilateral Mandibular Ramus Sagittal Split Osteotomy

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Lower-level laser therapy improves neurosensory disorders resulting from bilateral mandibular sagittal split osteotomy: A randomized crossover clinical trial

Residents' journal review

Altered Sensation After Orthognathic Surgery

Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review and Meta-Analysis