Bad Split Research Articles

Outcomes and complications of orthognathic surgery in older patients

PurposeSeveral studies have described the outcomes and complications following orthognathic surgery. However, the average patient age in these studies is 20–40 years. It is unclear whether results from these age groups can be extrapolated to older patients. MethodsThis retrospective observational study included 54 patients over 50 years of age, who underwent orthognathic surgery. From these patients’ medical records, we retrieved data regarding patient characteristics, surgery characteristics, outcomes, and complications. ResultsThe patients’ mean age was 56 years (range, 50–69 years), and mean ASA score was 2. A bad split occurred in one patient, and immediate postoperative complications occurred in two patients. There were no long-term sequelae. Neurosensory disturbances (NSD) occurred in 30 patients. Preoperative temporomandibular dysfunction (TMD) was present in 9 patients—among whom, five were cured after surgery. Four patients postoperatively developed de novo TMD. Hardware removal was performed in 22 patients. The mean length of stay was two days for monomaxillary procedures, and three days for bimaxillary procedures. ConclusionsThis study demonstrated apparent differences between patients over 50 years of age and the general orthognathic population. In particular, neurosensory disturbances and hardware removal were more prevalent in our study population.

The efficacy of alveolar ridge split on implants: a systematic review and meta-analysis

ObjectivesTo evaluate the effects of the alveolar ridge split (ARS) technique on gained horizontal width of the alveolar ridge and implant survival rate.Materials and methodsElectronic searching was performed in six electronic databases (Pubmed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, and SIGLE) from January 1, 2010, to November 1, 2023. Two authors performed study selection, data extraction, and study qualities (ROBINS-I and RoB 2.0) independently. Meta-analysis was performed by Comprehensive meta-analysis 3.0.Results24 included studies were observational, and 1 study was a randomized controlled trial (RCT). 14 studies investigated the gained width of the horizontal alveolar ridge, and 17 examined the implants’ survival rate. For assessment of risk of bias, nine studies were high risk of bias and 16 studies were moderate risk of bias. Meta-analysis demonstrated that the pooled gained alveolar ridge width was 3.348 mm (95%CI: 4.163 mm, 2.533 mm), and the implant survival rate was 98.1% (95%CI: 98.9%, 96.9%). Seven studies showed seven different complications including exposure, infection, bad split, dehiscence, fracture, paresthesia and soft tissue retraction.ConclusionRecent ARS technique seems to be an effective method of bone augmentation with enough gained width and a high implant survival rate. Further long-term and RCTs research remains needed to enhance the study quality.Clinical relevanceThe ARS technique could generate sufficient bone volume, and implants had a high-level survival rate. Therefore, ARS has been proposed to be a reliable horizontal bone augmentation technique that creates good conditions for the implantation of narrow alveolar crests.

Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus osteotomy?

AimThe purpose of this study was to evaluate the effect of adding a fourth osteotomy at the lower border of the mandible on the lingual cortical fracture pattern in bilateral sagittal split ramus osteotomies.Patients and methodsThe sample of the study consisted of 20 patients (12 male and 8 female, with a mean age of 26.79 ± 7.12 years) with mandibular deformities who needed bilateral sagittal split ramus osteotomy. One side underwent a traditional sagittal split ramus osteotomy, and the procedure was modified on the other side by adding a 1 cm horizontal osteotomy at the lower border of the mandible, just distal to the caudal end of the vertical buccal osteotomy cut. A 3D CBCT was used to identify the split pattern.ResultsIn the total sample, 40% of the lingual splits ran vertically toward the lower border of the mandible (LSS1), 20% of the splits passed horizontally to the posterior border of the mandible (LSS2), 32.5% of the splits took place along the inferior alveolar canal (LSS3), and 7.5% of the splits were unfavourable fractures (LSS4). On the inferior border osteotomy sides, the distribution of LSS1, LSS2, LSS3, and LSS4 was 10 (25%), 6 (15%), 4 (10%), and 0 (00), respectively. Their distribution on the sides without inferior border osteotomy was 6 (15%), 8 (20%), 13 (32.5%), and 3 (7.5%), respectively. Statistical analysis revealed a significant difference between the two groups (p < 0.05).ConclusionInferior border osteotomy tends to direct the lingual split fracture line toward the lower and posterior borders of the mandible and minimizes bad splits; however, further studies are needed to confirm our findings.

Computed tomography evaluation of risk factors for an undesirable buccal split during sagittal split ramus osteotomy.

Sagittal split ramus osteotomy (SSRO) sometimes induces an irregular split pattern referred to as a bad split. We investigated the risk factors for bad splits in the buccal plate of the ramus during SSRO. Ramus morphology and bad splits in the buccal plate of the ramus were assessed using preoperative and postoperative computed tomography images. Of the 53 rami analyzed, 45 had a successful split, and 8 had a bad split in the buccal plate. Horizontal images at the height of the mandibular foramen showed that there were significant differences in the ratio of the forward thickness to the backward thickness of the ramus between patients with a successful split and those with a bad split. In addition, the distal region of the cortical bone tended to be thicker and the curve of the lateral region of the cortical bone tended to be smaller in the bad split group than in the good split group. These results indicated that a ramus shape in which the width becomes thinner towards the back frequently induces bad splits in the buccal plate of the ramus during SSRO, and more attention should be paid to patients who have rami of these shapes in future surgeries.

Ortognatik Cerrahi Komplikasyonlarının Nedenleri ve Literatür Karşılaştırılması: Retrospektif Kohort Araştırma

Objective: This paper investigated the incidence, types, and reasons for complications of orthognathic surgery (OS). Material and Methods: The sample consisted of the medical records of 250 OS (141 women; 109 men) patients from April 2011 to February 2017. This study retrospectively analyzed follow-up files, radiographic images, and surgery notes and then classified participants for gender, malocclusion type, OS method, and complication. Complications were classified as preoperative, intraoperative, and postoperative. Statistical analysis was performed using IBM SPSS Statistics 21.0 (IBM Corp, Armonk, NY, USA). Descriptive data were calculated for each variable. Results: The mean age was 22.9±6.5 (minimum: 17; maximum: 55). The majority of participants (n=166) had Class III dentofacial deformity. Only 24 participants underwent Le Fort I osteotomy alone (12%). Participants had undergone bimaxillary (n=167; 66.8%), single jaw surgery (Le Fort I or sagittal split ramus osteotomy) (n=48; 19.2%), or other types of surgery (n=35; 14%). The patients were followed up for 12 months in the postoperative period. The only preoperative complication (4 patients-1.4%) was errors in planning (occlusal split incompatibility). The major intraoperative complications (38 patients-15.2%) were bad splits, heavy bleeding, and ruptured inferior alveolar neurovascular bundle. The postoperative complications (43 patients-17.2%) were infection, fixation-related problems, neurosensory and temporomandibular joint disorders, facial paralysis, nasal septum deviation, and malunion-nonunion. The total rate of complications was 27.2% (68 patients). Conclusion: OS operations are generally safe operations that can be easily managed, although they may rarely cause serious life-threatening complications.

Infralingular Versus Supralingular Medial Osteotomy in Sagittal Split Osteotomy of the Mandible: A Randomized Control Study

A recently proposed modification of the sagittal split osteotomy (SSO) of the mandible places the horizontal medial cut 'low and short' of the lingula. The purpose of the study was to answer the following clinical question: Among patients undergoing mandibular setback procedures (≤ 8mm) via SSO, does the placement of the medial horizontal osteotomy below the lingula (infralingular), when compared to placement above the lingula (supralingular), results in different neurosensory, bite force, and range of motion outcomes? This was a single-center, double-blind, parallel-group study among patients undergoing mandibular setback by SSO (≤ 8mm), between January 2021 and September 2022. Patients were randomly allocated in a ratio of 1:1 to the supralingular (control) and the infralingular (study) group. Primary outcome variables included neurosensory disturbance of the inferior alveolar nerve based on clinical neurosensory testing and severity graded using Zuniga and Essick's protocol, bite force, and maximum mouth opening evaluated postoperatively during the first week (T1), first month (T2), and third month (T3) of follow-up. Secondary outcome measures included the incidence of a bad split and distal segment interferences intraoperatively. Association between the variables was assessed using Pearson chi-squared test or Fisher's exact test based on the expected observations. A P value of ≤.05 was considered statistically significant. A total of 29 patients (58 osteotomies) were included in the study. Group 1 consisted of 15 patients (9 females and 6 males) with a mean age of 26.4years. Group 2 consisted of 14 patients (8 females and 6 males) with a mean age of 25.9years. Patients with severe neurosensory disturbance of the inferior alveolar nerve were more common in group 2 (n=15, 53.6%) than group 1 (n=4, 13.3%) at T1 (P value=.0001) and insignificant between the two groups at T2 (P value=.63) and T3 (P value=.99). Comparison of maximum mouth opening between the two groups at T1 (P value=.535), T2 (P value=.934), and T3 (P value=.703) and bite force at T1 (P=.324), T2 (P=.113), and T3 (P=.811) was not significant. Both SSO techniques have similar clinical outcomes among patients having mandibular setbacks (≤ 8mm) for the variables studied.

Correlation between mandibular anatomy and bad split occurrence during bilateral sagittal split osteotomy: a three-dimensional study.

This study aimed to find out the correlation between different anatomical parameters of the mandible and the occurrence of a bad split in patients who had undergone bilateral split sagittal ramus osteotomy (BSSRO). At both the distal roots of the first molar (1) and the retromolar area (2), we measured the distance from the buccal margin of the inferior dental canal (IDC) to the buccal margin of the cortical bone (MCBC), the thickness of both buccal cortical (WBCB) and cancellous bone (WBCA), distance from the superior border of IDC to the alveolar crest (MCAC), buccolingual thickness (BLT), and thickness of cancellous bone (WCA). At the ramus, the distances between the sigmoid notch to the upper part of the lingula (SL) and the inferior border of the mandible (SIBM), the thickness of the ramus at the level of the lingula (BLTR), and the anteroposterior width of the ramus (APWR) were measured. The paired and independent t-tests were used when applicable, and a P-value < 0.05 was considered significant. MCBC1 showed a significant difference between bad and non-bad split sides (P = 0.037). Both WBCA1 and WBCA2 show the same significant difference (P = 0.023, 0.024). Similarly, WCA1 and WCA2 showed a statistical difference between the bad and non-bad split sides (P = 0.027, 0.036). There were no statistically significant differences between the compared sides of WBCB1, WBCB2, MCAC1, MCAC2, SIBM, APWR, SL, and BLTR. Narrow space between IDC and the buccal cortical margin, along with the decrease in the thickness of both buccal cancellous bone and total cancellous bone at the inferior border of the mandible along the course of SSRO, has been implicated in the occurrence of bad split intraoperatively.

Bad splits in bilateral sagittal split osteotomy: A retrospective comparative analysis of the use of different tools

This study aims to analyse the relationship between the incidence of bad splits and the surgical tools adopteded to perform bilateral sagittal split ramus osteotomy (BSSRO).BSSROs performed by the same experienced surgeon period were reviewed, retrospectively. The patients were divided into three groups according to the surgical instrument used to perform the osteotomy: a Lindemann burr, reciprocating saw or piezosurgery. Among the 1120 BSSROs performed, 5 bad fractures were detected during the observation period: 3 among patients operated with the Lindemann burr (0.8%) and 2 among those operated with a reciprocating saw (0.5%). There was no significant correlation between the bad split rate and age and gender of the patients, the type of malocclusion or the type of instrument used to perform the osteotomy.Within the limitations of the study it seems that the the choice of the osteotomy tool for BSSRO does not influence the rate of bad fractures and, therefore, the selection of the osteotmy tool should be left to the discretion of the surgeon.

Management of A Bad Split Complication: A Systematic Review

Introduction: Bad split is one of the well-known intra-operative complications that occur during the bilateral sagittal split osteotomy (BSSO) procedure, which is a rehabilitation procedure for patients with mandibular deformities. The prevention of further post-surgery complications required sufficient management of bad split complications. Objective: This study aimed to analyze the management of bad split complications during a BSSO procedure. Methods: The literature review was conducted in the form of library research in the field of bad split complications' management by a BSSO based on the Preferred Reporting Items for Systematic Reviews (PRISMA). Related studies were found through using a manual search using Pubmed, ScienceDirect, Ebscohost, Scopus, Medline, Embase, and Web of Science, among other search engines. The inception of incorporation standards, the process of data extraction, and the determination of the risk of bias were carried out by the authors. The process of data screening was conducted by applying the inclusion and exclusion criteria. Results: This paper systematically reviewed seven related studies, four of which were case series and two of which were cross-sectional. The utilization of additional osteosynthetic plates was revealed throughout the extraction process as the most acquainted course of action to manage the bad split complications during the BSSO procedure. Conclusion: The osteosynthetic plate and miniplate application with bicortical or monocortical screws were exposed as the most used treatment for bad split complications.

Comparison of two surgical techniques (HOO vs. BSSO) for mandibular osteotomies in orthognathic surgery—a 10-year retrospective study

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.

Effect of modified bilateral sagittal split osteotomy on inferior alveolar nerve neurosensory disturbance

The aim of this study was to assess the occurrence of neurosensory disturbance of the inferior alveolar nerve (IAN) following modified mandibular bilateral sagittal split osteotomy (BSSO) that preserves the mandibular inferior border. All patients undergoing BSSO, associated or not with a Le Fort I osteotomy (performed by the same senior operator) between January 2018 and December 2019, were eligible. The modified BSSO consists of a modification of the technique described by Epker: the bony section of the buccal cortex stops 3-4 mm above the basal mandibular edge. While respecting the basilar border, sectioning is then performed up to the gonial angle where bicortical section is finally performed. Sensibility of the labial and chin area was evaluated immediately postoperatively, and at six months and two years of follow up. A total of 140 eligible patients underwent the modified BSSO between January 2018 and December 2019, and 72 were included. Hypoaesthesia was found in 81.9% of the patients (59/72 patients) at initial evaluation. It decreased to 45.8% (33/72 patients) at the six-month examination and to 12.5% (9/72 patients) at the last examination. Four bad splits were recorded. The modified BSSO preserves the inferior border of the mandible and maintains the IAN in the lingual fragment. There is no need to release the IAN, hence its manipulation is reduced and the incidence of IAN postoperative hypoaesthesia is also reduced.

A clinico-statistical study of factors associated with intraoperative bleeding in orthognathic surgery

BackgroundExcessive bleeding is a major intraoperative risk associated with orthognathic surgery. This study aimed to investigate the factors involved in massive bleeding during orthognathic surgeries so that safe surgeries can be performed. Patients (n=213) diagnosed with jaw deformities and treated with bimaxillary orthognathic surgery (Le Fort I osteotomy and bilateral sagittal split ramus osteotomy) in the Department of Oral and Maxillofacial Surgery at the Suidobashi Hospital, Tokyo Dental College between January 2014 and December 2016 were included. Using the patients’ medical and operative records, the number of cases according to sex, age at the time of surgery, body mass index (BMI), circulating blood volume, diagnosis of maxillary deformity, direction of maxillary movement, operative duration, incidence of bad split, injury of nasal mucosa, and blood type were analyzed.ResultsThe results revealed that BMI, circulating blood volume, nasal mucosal injury, and operative time were associated with the risk of intraoperative massive bleeding in orthognathic surgeries. Chi-square tests and binomial logistic regression analyses showed significant differences in BMI, circulating blood volume, direction of maxillary movement, operative duration, and injury to the nasal mucosa. Operative duration emerged as the most important risk factor. Furthermore, a >4-mm upward migration of the posterior nasal spine predicted the risk of massive bleeding in orthognathic surgery.ConclusionsThe upward movement of the maxilla should be recognized during the preoperative planning stage as a risk factor for intraoperative bleeding, and avoiding damage to the nasal mucosa should be considered a requirement for surgeons to prevent massive bleeding during surgery.

Retrospective examination of complications observed in orthognathic surgical surgery in 85 patients.

The aim of our study is to examine the possible complications, risk factors, and solutions encountered in orthog-nathic surgery in the light of the cases; we performed in our clinic. This study includes a retrospective analysis of the records of 85 patients who underwent orthognathic surgery between 2015 and 2020 in Istanbul Pendik District Hospital Oral and Maxillofacial Surgery Service. The types of complications encountered during the operations were recorded in the study. Independent variables such as gender, age, number of operations, surgical site, and type of osteotomy were evaluated. Complications were evaluated according to the Clavien-Dindo classification. The data were pre-sented for statistical analysis with a significance level of 0.05. Of the 85 patients included in the study, 40 were male and 45 were female. Of these patients, 65 had double chin operation and 20 had single chin operation. A total of 150 jaw osteotomies were performed, 78 of them in the maxilla and 72 in the mandible. While the maxilla was operated in 13 of the cases, in which single jaw operation was performed, only the mandible was treated in 7 of them. Complications were observed in 24 (10.57%) of a total of 227 osteotomies. Among the complications encountered, bleeding (8), nerve damage (7), malocclusion (3), infection (2), TMJ problems (2), bad split (1), and deviation at the tip of the nose (1) stand out, while complications were observed equally in men and women, complications were observed more frequently in cases with longer operative time (p<0.05). Complications were observed more frequently in bilateral sagittal split osteotomies (p<0.001) compared to Le Fort 1 osteotomies. Clavien-Dindo grade I complications were most common (72.04%) depending on the treatment. According to the Clavien-Dindo classification, there was no relationship between gender, age, duration of surgery, length of hospital stay, or surgical site, and the degree of complications (p≥0.05). Post-operative malocclusion, bleeding, inferior alveolar nerve injury, infection, poor division, and infection are the most common complications in orthognathic surgery. It can be associated with factors such as the duration of the operation, the number of operations, the site of the operation, and the type of osteotomy which performed. It is thought that positive contributions can be made to the success of the surgery by considering these factors in the treatment planning, during the operation and in the post-operative follow-up part.

Genel Anestezi Altındaki Ortognatik Cerrahi Prosedürlerinin Perioperatif Olarak Değerlendirilmesi: Retrospektif Bir Çalışma

Objective: The reconstruction of dentofacial deformities via orthognathic surgery is one of the procedures in oral and maxillofacial surgery. Several complications can occur-related to general anesthesia and prolonged operating time. The aim of this study was to investigate the effect of type of the skeletal deformity and the type of orthognathic surgery on anesthesia-related complications. Two hundred and two patients who underwent orthognathic surgery under general anesthesia were evaluated retrospectively. Material and Methods: According to inclusion criteria, 114 patients were included in the study. The patients were divided into two groups according to their surgical operations as single jaw (n=41) and double jaw (n=73) surgery. Ninety seven patients have skeletal Class 3 deformity and 17 patients have Class 2 deformity. The incidence of intraoperative surgical complications, duration of surgery, intubation difficulty, blood transfusion, postoperative intensive care and/or usage of additional medication were descriptively analyzed. Anesthesia-related complications were statistically compared between the groups. Results: The most common surgery-related complication was bad split. The incidence of life-threatening complications such as extensive blood loss or pulmonary edema was slightly higher in skeletal Class 2 patients and in double jaw surgery group. Although there was no statistically significant difference between the groups, both Mallampati score and difficult intubation scores were higher in skeletal Class 2 groups. Conclusion: Surgeon should be aware of prolonged surgery time can increase the complication risk while anesthesiologist should be aware of the Class 2 skeletal deformity-related intubation difficulties.

Intraoperative removal of third molars does not affect the postoperative infections after BSSO - Randomized controlled trial

The goal of this study was to evaluate the incidence of postoperative wound infection and timing of mandibular third molar removal in bilateral sagittal split osteotomy (BSSO).This wis a prospective, single-blinded, randomized, split-mouth clinical trial. All patients were divided into two groups: Group I, where pre-operative removal of the third molars were done 6 months prior to BSSO and Group II, where intra-operative removal of contralateral third molars were done for the same patients during the osteotomy. The primary outcome variable studied was postoperative infection rate and the secondary outcome variable was bad split during BSSO.Among the seventy five patients (150 sites), one site in group II developed infection whereas none of the sites in group I developed infection (p = 1.000). No sites had bad split in both the groups.The results from the present study show that there is no difference between the presence or absence of mandibular third molars on post-operative wound infection following bilateral sagittal split osteotomy, and the authors hence suggest removing third molars during BSSO for patient comfort.

Is the Low and Short Medial Horizontal Osteotomy a Predictive Factor for Bad Splits in Sagittal Split Osteotomies?

Statement of the problemThe purpose of this study is to determine whether a low and short medial horizontal osteotomy is a predictive factor for determining bad splits in non-syndromic patients undergoing sagittal split osteotomies for dentofacial disorders. Materials and methodsA retrospective cohort analysis was conducted on subjects who received orthognathic surgery from 2017 to 2019 at Parkland Memorial Hospital. Inclusion criteria were a traditional osteotomy defined by Hunsck and Epker or a low and short osteotomy defined by Posnick.1,2 Exclusion criteria were the diagnosis of a syndromic condition, repeat surgery, or concomitant temporomandibular joint surgery. The predictor variable was the type of osteotomy performed, defined as either a low and short or traditional osteotomy. The primary outcome variable was the occurrence of a bad split. Secondary predictor variables were age and sex, defined as male or female, and faculty side (right side) versus resident side (left side). Descriptive, bivariate, and multiple logistic regression analyses were performed with P < .05 used to determine statistical significance. Results and outcomesFifty-nine patients met the defined inclusion criteria. The average age at the time of surgery was 21 years old. The cohort consisted of 27 males and 32 females. Thirty-six patients were treated with bilateral low and short osteotomies, and 23 patients were treated with bilateral traditional osteotomies. Of the 118 total osteotomies performed, there were a total of 9 bad splits (7.6%). There were 3 right-side bad splits and 6 left-side bad splits. The occurrence of a right-side bad split was 3 for the low and short group and 0 for the traditional group. The occurrence of a left-side bad split was 4 for the low and short group and 2 for the traditional group. There were no significant differences between the type of osteotomy performed and the occurrence of a right-side bad split (P = .1607) or a left-side bad split (P = .7695). There was no significant difference between sex and occurrence of a right-side bad split (P = .6640) or a left-side bad split (P = .2862). There was no significant difference between age and occurrence of a right-side bad split (P = .5233) or a left-side bad split (P = .4492). There was no significant difference between faculty side and resident side with regards to bad splits (P = .4903). Discussion and conclusionThe sagittal split osteotomy (SSO) was first reported by Trauner and Obwegeser in 1955, with the horizontal medial osteotomy further modified by Hunsuck to terminate superior and posterior to lingula.1 Posnick developed an additional modification of the SSO to reduce the frequency of unfavorable splits toward the condyle by modifying the medial horizontal osteotomy to terminate below lingula at the level of the mandibular occlusal plane (low) and anterior to lingula (short).2 The occurrence of bad splits using the traditional osteotomy ranges from 1% to 23%, while the incidence of bad splits reported by Posnick in his retrospective analysis was 0%. The results of the present study suggest a low and short osteotomy is at least as reliable as the traditional osteotomy with regards to intraoperative bad splits. Future prospective studies, including split-mouth study designs by this group, will further elucidate the low and short osteotomy as a reliable alternative to the traditional osteotomy.1.The low medial horizontal osteotomy in patients with atypical ramus morphology undergoing sagittal split osteotomy2.Occurrence of a ‘bad’ split and success of initial mandibular healing: a review of 524 sagittal ramus osteotomies in 262 patients

Dal Pont vs Hunsuck: Which Technique Can Lead to a Lower Incidence of Bad Split during Bilateral Sagittal Split Osteotomy? A Triple-blind Randomized Clinical Trial.

BACKGROUNDWe aimed to assess the incidence of bad split fractures during Bilateral Sagittal Split Osteotomy (BSSO) mandibular setback surgery using Dal Pont and Hunsuck techniques.METHODSAll healthy adults with skeletal class III discrepancy, who were candidates for mandibular setback surgery were enrolled in this randomized clinical trial in the Maxillofacial Surgery Department of Qaem Hospital, Mashhad, Iran; from 2018-2020. These patients were randomly divided into two equal groups; one group underwent BSSO using Dal Pont osteotomy while the Hunsuck osteotomy was employed for the other group. A bad split fracture which identified through intra-operative clinical and postoperative radiographic examination was the outcome variable. The significance level was set at 0.05 using SPSS 16.RESULTSOverall, 104 consecutive patients, comprising of 52 (50%) males with an average age of 23.09±3.08 were recruited. The average duration of osteotomy and splitting was reported to be 22.74±3.06 min. 10 bad split fractures (9.62%) were observed; 7 of which occurred in the Dal Pont group and 3 in the Hunsuck group. However, this difference was not significant. In 80% of the cases, bad split osteotomy occurred in the proximal segment, while this finding was identified in the distal segment in 20% of cases. The average duration of osteotomy and splitting was significantly longer in the Dal Pont group (P<0.001).CONCLUSIONThe duration of osteotomy and splitting is much shorter when the Hunsuck technique is employed, and the incidence of unfavorable fractures is also less compared to the Dal Pont osteotomy technique.

Dal Pont vs Hunsuck: Which Technique Can Lead to a Lower Incidence of Bad Split during Bilateral Sagittal Split Osteotomy? A Triple-blind Randomized Clinical Trial

Dal Pont vs Hunsuck: Which Technique Can Lead to a Lower Incidence of Bad Split during Bilateral Sagittal Split Osteotomy? A Triple-blind Randomized Clinical Trial

A Clinical Re-Evaluation of an Unexplored Technique for Post Gap Arthroplasty Retrognathic Mandible.

The current manuscript explores the viability of reverse sagittal split osteotomy technique for correction of ankylotic cases with post gap arthroplasty mandibular retrognathia to achieve socially acceptable esthetic results. Reverse sagittal split osteotomy which was introduced by Collins et al in 1983 was performed with certain modifications on two cases to correct mandibular hypoplasia in post gap arthroplasty cases. The paper also highlights intraoral as well as extraoral approach for performing the osteotomy along with better management of bad split under direct vision. It was observed that the reverse sagittal split technique for advancement of mandible in cases of tmj ankylosis-induced dentofacial deformity provided better proximal control, reduced chances of bad split, greater range of advancement (11-14 mm) with esthetically acceptable results. The osteotomy cuts on lateral surface of mandible make the procedure effectively easier and quicker with better control over proximal segment and management under direct vision. When Distraction Osteogenesis and conventional orthognathic is not a choice in management of dentofacial deformity of post-release ankylosis cases due to the poor proximal control and concern over bad split, reverse sagittal split can be an appropriate choice to manage these deformities without any donor site morbidity.

Sagittal Split Ramus Osteotomy in the Shortest Buccal Bone Marrow Distances of the Mandible on the Coronal Plane.

Purpose This study investigated the relationship between the shortest buccal bone marrow of the ramus and skeletal patterns. Materials and Methods Using cone-beam computed tomography data (specifically, the A point-nasion-B point (ANB) angle), we divided patients into three groups as follows: skeletal class I (0° < ANB < 4°), class II (ANB: ≥4°), and class III (ANB: ≤0°). Sixteen vertical sections in the coronal plane were taken starting from slice 0 (original intact mandibular canal) anteriorly at 2 mm intervals to slice 15 (30 mm). The thickness of the mandible (M) and shortest buccal bone marrow (SBM) were measured. The data of SBM were divided into two groups (SBM ≥ 1 mm and SBM < 1 mm). For each skeletal pattern, an SBM value < 1 mm was considered to indicate a high possibility of postoperative nerve paresthesia and bad split. Results The three skeletal pattern groups also did not significantly differ in their M values for all sections. The mean SBM values of class III (0.91–2.11 mm) at 6–16 mm anterior to the mandibular foramen were significantly smaller than those of class II (1.53–3.17 mm). Comparing the occurrence ratio of SBM < 1 mm, the highest and lowest probabilities in class III (55% and 21.7%, respectively) were significantly larger at 6–20 mm anterior to the mandibular foramen than those in class II (28.3% and 5%, respectively). Conclusion Class III had a significantly shorter SBM distance and higher SBM occurrence probability than class II at the mandibular ramus region, implying that class III participants are more likely than class II participants to have nerve paresthesia and bad split after sagittal split ramus osteotomy.