Bilateral sagittal split osteotomy (BSSO) is a widely used orthognathic surgery technique. This prospective observational study investigated the correspondence between the planned inferior border... Show moreBilateral sagittal split osteotomy (BSSO) is a widely used orthognathic surgery technique. This prospective observational study investigated the correspondence between the planned inferior border cut and the actually executed inferior border cut during BSSO. The influence of the inferior border cut on lingual fracture patterns was also analyzed.Postoperative cone beam computed tomography (CBCT) scans of 41 patients, representing 82 sagittal split osteotomies, were investigated. The inferior border cut was intended to penetrate completely through the caudal cortex. Descriptive statistics were used to analyze the executed inferior border cuts. Mixed models were used to investigate the influence of independent variables such as the surgeon's experience on the inferior border cut. Secondarily the influence of the inferior border cut on lingual fracture patterns and the incidence of bad splits was assessed.The inferior border cut reached the caudal cortex in all cases, but reached the lingual cortex in only 38% of the splits. There was no significant relationship between the inferior border cut and a specific lingual fracture line.In this study, postoperative CBCT analysis revealed that the bone cuts during BSSO were often not placed exactly as planned. No significant relationship between the inferior border cut and lingual fracture patterns or bad splits was, however, detected. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. Show less
The most common complications that are associated with bilateral sagittal split osteotomy are: bad splits, postoperative infection, removal of osteosynthesis material, and neurosensory disturbances... Show moreThe most common complications that are associated with bilateral sagittal split osteotomy are: bad splits, postoperative infection, removal of osteosynthesis material, and neurosensory disturbances of the lower lip. Particularly in elective orthognathic surgery, it is important that surgeons inform their patients about the risk of these complications and attempt to minimize these risks. The purpose of this literature review and meta-analysis is to provide an overview of these common complications and their risk factors.After a systematic electronic database search, 59 studies were identified and included in this review. For each complication, a pooled mean incidence was computed. Both the pooled study group and the pooled 'complication group' were analysed.The mean incidences for bad split (2.3% per SSO), postoperative infection (9.6% per patient), removal of the osteosynthesis material (11.2% per patient), and neurosensory disturbances of the lower lip (33.9% per patient) are reported. Regularly reported risk factors for complications were the patient's age, smoking habits, presence of third molars, the surgical technique and type of osteosynthesis material. This information may help the surgeon to minimize the risk of these complications and inform the patient about the risks of complications associated with bilateral sagittal split osteotomy. (C) 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. Show less
Verweij, J.P.; Mensink, G.; Houppermans, P.N.W.J.; Merkesteyn, J.P.R. van 2015
Purpose: The traditional osteotomy design in the bilateral sagittal split osteotomy includes a horizontal lingual bone cut, a connecting sagittal bone cut, and a vertical buccal bone cut... Show morePurpose: The traditional osteotomy design in the bilateral sagittal split osteotomy includes a horizontal lingual bone cut, a connecting sagittal bone cut, and a vertical buccal bone cut perpendicular to the inferior mandibular cortex. The buccal bone cut extends as an inferior border cut into the lingual cortex. This study investigated a modified osteotomy design including an angled oblique buccal bone cut that extended as a posteriorly aimed inferior border cut near the masseteric tuberosity.Materials and Methods: The authors implemented a randomized controlled study. The study sample was comprised of 28 cadaveric dentulous mandibles. The primary outcome variable was the pattern of lingual fracture induced using the conventional (n = 14) and modified (n = 14) osteotomy designs. The secondary outcome variables included the incidence of bad splits and the status of the inferior alveolar nerve (IAN). Descriptive and bivariate statistics were computed.Results: The angled osteotomy design resulted in a significantly larger number of the lingual fractures originating from the inferior border cut (odds ratio [OR] = 1.54; 95% confidence interval [CI], 1.27-1.86; P < .01), with a significantly more posterior relation of the fracture line to the mandibular canal (OR = 2.11; 95% CI, 1.22-3.63; P < .01) and foramen (OR = 1.99; 95% CI, 1.28-3.08; P < .01). No bad splits occurred with the angled design, whereas 3 bad splits occurred with the conventional design, although this difference was not statistically significant (OR = 1.11; 95% CI, 0.99-1.25; P = .07). IAN status was comparable between designs, although the nerve more frequently required manipulation from the proximal mandibular segment when the conventional design was used (OR = 1.21; 95% CI, 0.99-1.47; P = .06).Conclusion: The results suggest that the angled osteotomy design promotes a more posterior lingual fracture originating from the inferior border cut and a trend was apparent that this also might decrease the incidence of bad splits and IAN entrapment. These results must be carefully extrapolated to the clinical setting, with future studies clarifying these findings. (C) 2015 American Association of Oral and Maxillofacial Surgeons Show less
In bilateral sagittal split osteotomy the proximal and distal segments of the mandible are traditionally separated using chisels. Modern modifications include prying and spreading the segments with... Show moreIn bilateral sagittal split osteotomy the proximal and distal segments of the mandible are traditionally separated using chisels. Modern modifications include prying and spreading the segments with splitters. This study investigates the lingual fracture patterns and status of the nerve after sagittal split osteotomy (SSO) using the traditional chisel technique and compares these results with earlier studies using the splitter technique.Lingual fractures after SSO in cadaveric pig mandibles were analysed using a lingual split scale and split scoring system. Iatrogenic damage to the inferior alveolar nerve was assessed.Fractures started through the caudal cortex more frequently in the chisel group. This group showed more posterior lingual fractures, although this difference was not statistically significant. Nerve damage was present in three cases in the chisel group, but was not observed in the splitter group.A trend was apparent, that SSO using the chisel technique instead of the splitter technique resulted in more posterior lingual fracture lines, although this difference was not statistically significant. Both techniques resulted in reliable lingual fracture patterns. Splitting without chisels could prevent nerve damage, therefore we propose a spreading and prying technique with splitter and separators. However, caution should be exercised when extrapolating these results to the clinic. (C) 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. Show less
