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

Objective: The objective of this study was to investigate of the effect of piezzo and conventional osteotomy techniques on bone reserve in the osteotomy line and comminuted fracture ratios that is able to compromise bone to bone contact negatively. Methods: Bilateral sagittal split ramus osteotomy was performed on 12 fresh male Thracian curly caprine mandible. In the first group (n: 12) osteotomies were performed with piezzo device. In the second group (n: 12) osteotomies were performed with micromotor and manual osteotomes. Operative time was measured. The number of comminuted fractures, length and width of the osteotomy, and the space between the osteotomy lines was evaluated from 3-dimensional computed tomography scans. Results: The mean value of procedure duration was 320.4±10.76 seconds for piezo osteotomy and 238.8±8.29 seconds for conventional micromotor (P<0.0001). Number of comminuted fractures was 1.41±1.3 in piezoelectric group, 1.5±1.3 in conventional group and the difference was not statistically significant (p: 0,88). Osteotomy lengths and widths were 35.58±5.2, 2.196±1.9 and 36.23±5.05, 2.27±1.85 in the piezzo and conventional groups, respectively. (plengths:0,75; pwidths:0,92) The volume of the bony interface between the distal and proximal segments of the mandible after osteotomy was 166.3±184.2 mm3 in the piezzo group and 163.5±129.3 mm3 in the conventional group (p: 0,96). Conclusion: The piezo surgery and the conventional osteotomy were found to be similar in terms of the gap between the distal and proximal mandible and the number of comminuted fractures. The duration to perform the conventional osteotomy was found to be shorter than the piezo surgery.

Section: Discussionsupporting

confidence: 92%

Impact of Different Osteotomy Techniques on Bone Reserve in the Osteotomy Line in Sagittal Split Osteotomy: Experimental In Vitro Study in Caprine Mandible Model

Toplu,

Altinel,

Evin

et al. 2023

“…Key Words: Basal cell, carcinoma, complications, surgery B asal cell carcinoma (BCC) is the most frequent skin malignancy worldwide, accounting for 70% to 80% of all skin malignancies, with 80% of cases occurring on the head and neck region. [1][2][3] The rate is constantly increasing, and the highest rise is observed in Europe, where the incidence has increased 5% in the past 10 years. 1 The majority of BCCs grow slowly and have a low metastatic potential.…”

Section: Discussionmentioning

confidence: 99%

“…1 Bad splitting is considered one of the most serious complications in BSSO since it can lead to deleterious effects on the procedure and the end result, with an incidence reaching up to 14.7 per side. 2,3 Many risk factors were proposed to influence the occurrence of bad splitting such as lateral bone cut end (LBCE), the presence of impacted mandibular third molars, and ramal thickness. 4,5 Attempts have been made to classify the lingual splitting patterns and to study the possible influencing factors using cone beam computed tomography (CBCT).…”

mentioning

confidence: 99%

Evaluation of the Lingual Splitting Patterns and the Lateral Bone Cut Ends Following Mandibular Bilateral Sagittal Split Osteotomy Using Cone Beam Computed Tomography (CBCT)

Khaleel¹,

Bede

2023

The bilateral sagittal split osteotomy (BSSO) is the most popular orthognathic procedure performed by maxillofacial surgeons to treat skeletal class II and class III and to correct mandibular asymmetries. The study aimed to evaluate the lingual splitting patterns and lateral bone cut end (LBCE) in bilateral sagittal split osteotomy (BSSO) and their relation with the ramal thickness and the presence of impacted third molars using cone beam computed tomography (CBCT). This prospective observational study included patients with mandibular prognathism who were treated with BSSO with or without Le Fort I osteotomy. Cone beam computed tomography was used to measure the ramal thickness preoperatively and to evaluate the LBCE, and the lingual splitting patterns postoperatively. Twenty-one patients (42 sides) were included in this study. The most commonly observed lingual splitting pattern was type III (47.6%), while the most common LBCE was type B (59.5%). The bad split was encountered 8 times on 42 sides (16.7%). A nonsignificant relationship between the ramal thickness and bad splitting was observed (P=0.901). Impacted third molars were present in 16 of the 42 sides (38.1%) and had no significant effect on the occurrence of bad splitting (P=0.063). Type III lingual splitting pattern and type B LBCE were the most commonly observed patterns. No direct association was observed concerning the presence of impacted mandibular third molars and the thickness of the ramus with the occurrence of bad splitting.

“…Although the bone can be effectively cut, these techniques may result in complications. Due to the difficulty in controlling the tool, there is a risk of entrapment of the surrounding soft tissue, leading to nerve damage and bleeding 4 . Bleeding in a narrow surgical field interferes with accurate surgical maneuvers and prolongs the surgical time.…”

mentioning

confidence: 99%

“…Due to the difficulty in controlling the tool, there is a risk of entrapment of the surrounding soft tissue, leading to nerve damage and bleeding. 4 Bleeding in a narrow surgical field interferes with accurate surgical maneuvers and prolongs the surgical time. Therefore, it is essential to avoid these complications by performing osteotomies safely and quickly.…”

mentioning

confidence: 99%

Advantages of a High-Powered Ultrasonic Vibration Cutting Device for Orthognathic Surgeries

Sato,

Imai

2023

This study aimed to evaluate the advantages of using a high-powered ultrasonic vibration cutting device (HP-UVCD) in orthognathic surgeries. We analyzed 22 consecutive patients who underwent Le FortⅠosteotomy and bilateral sagittal split osteotomies for cleft lip and palate. We used conventional power instruments, such as reciprocating saws and rotating burrs in the first 10 patients, and an HP-UVCD in the remaining 12 patients. Surgical time, intraoperative blood loss, and postoperative inferior alveolar nerve affection were retrospectively investigated. The surgical time in the ultrasonic group (223±12.217 min) was significantly shorter than that in the conventional group (278±11.153 min, P=0.008). The amount of intraoperative blood loss in the ultrasonic group was an average of 230±45.154 g, and that in the conventional group was an average of 343±49.463 g. Although the blood loss in the ultrasonic group was reduced compared with that in the conventional group, this difference was not statistically significant (P=0.118). All patients in both groups recovered normal sensation by 6 months postoperatively. Our findings suggest that the HP-UVCD can be used in place of a reciprocating saw or rotating burrs in orthognathic surgeries, resulting in reduced surgical time and minimal blood loss. The use of an ultrasonic bone-cutting device may allow for a safer and less invasive orthognathic surgery.