Is Bilateral Sagittal Split Osteotomy of the Mandible With no Step Possible? A Modification in the Technique

Mont'Alverne, Antonio Lopes Filho; Xavier, Felipe; Meneses, Anderson Maia; Santos, Eliardo Silveira; Franco, Jéferson Martins Pereira Lucena

doi:10.1097/scs.0000000000005653

Cited by 9 publications

(6 citation statements)

References 3 publications

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“…This cut extends from the mandibular angle to the lower end of the vertical buccal cortical osteotomy. Lower medial cortical osteotomies and a fourth horizontal osteotomy immediately above and parallel to the lower border were carried out by Mont’Alverne et al [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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

Al-Dawoody,

Hamad,

Kheder Khrwatany

et al. 2023

Head Face Med

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Aim The 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 methods The 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. Results In 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). Conclusion Inferior 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.

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Section: Introductionmentioning

confidence: 99%

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

Al-Dawoody,

Hamad,

Kheder Khrwatany

et al. 2023

Head Face Med

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“…Bilateral sagittal split ramus osteotomy (BSSRO) is a technique of orthognathic surgery that is utilized to adjust excess, deficiency, and asymmetry of the mandible [1]. The sagittal split osteotomy was described by Trauner and Obwegeser and then modified by DalPont and Epker et al [2].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of low-level laser therapy on recovery from neurosensory disturbance after sagittal split ramus osteotomy: a systematic review and meta-analysis

Firoozi

Keyhan

Kim

et al. 2020

Maxillofac Plast Reconstr Surg

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Background Orthognathic surgery such as bilateral sagittal split ramus osteotomy (BSSRO) for the treatment of mandibular deformities is one of the most common procedures in maxillofacial operations that may lead to neurosensory disturbance. In this study, we aimed to evaluate the effectiveness of low-level laser therapy (LLLT) on augmenting recovery of neurosensory disturbance of inferior alveolar nerve (IAN) in patients who underwent BSSRO surgery. Methods A comprehensive literature search was conducted by two independent authors in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, Embase, and Google Scholar electronic databases. Besides, a manual search of all textbooks and relevant articles were conducted. Searches took place in August 2020 and were limited to published and peer-reviewed articles from 2000 to 2020. All analysis was performed using the comprehensive meta-analysis (CMA) and the STATA MP (version:16) software. The weighted mean difference (WMD) using the inverse variance method and the standard mean difference (SMD) was considered for continuous variables. Results Seventy-four papers were retrieved after removing duplicate studies and finally, eight studies were assessed for qualitative synthesis and five for meta-analysis. Totally, 94 patients were included in the meta-analysis. Based on the meta-analysis, it was shown that LLLT was not effective in a short interval (0 to 48 h) after surgery, but in a period of more than 1 month after surgery, the positive results of treatment can be observed strikingly. Also, LLLT side/group showed no significant difference in some aspects of neurosensory recovery such as thermal sensation compared to the placebo side/group. Conclusions The meta-analysis of randomized controlled trials revealed that LLLT generally improves IAN sensory disturbance caused by BSSRO. Further high-quality clinical trials with longer follow-up periods and larger sample sizes are recommended.

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“…Mont'Alverne et al in 2019 described an osteotomy similar to the design shown in this paper, however, specific indications, advantages and disadvantages for its use are not clarified [11]. The obtained preliminary results of this report can elucidate advantages of using this design such as the preservation of contact area for fixation between both segments, the protection of the vascular facial bundle in the ante-gonial notch by avoiding a cut on the lower border of the mandible, the preservation of the masseteric cinch insertion that cant be achieved by the angular osteotomy reported by Verweij et al [19], it reduces the need for implants or grafts in the gonial area for rounded faced patients, also eliminates the palpable step in the basilar and gonial outlines [11]. In addition, the step permits a better control of the position of the proximal segment limiting its auto-rotation.…”

Section: Discussionmentioning

confidence: 91%

“…1-3 ). Then a bicortical horizontal osteotomy is performed 5 to 8 mm above the basilar border of the mandibles angle, starting at the posterior border of the mandible in a posteroanterior direction to unify the osteotomies at the ante-gonial notch area where the previous cut was left [11]. The split is completed using osteotomes as conventional.…”

Section: Surgical Procedures and Technique Descriptionmentioning

confidence: 99%

A modified sagittal split osteotomy: description of technique

Castillo

Naranjo

2022

J Oral Med Oral Surg

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The mandibular ramus bilateral sagittal split osteotomy (BSSO) is the common approach in orthognathic surgery; however, this design has some limitations to achieve a good definition in the angle of the jaw in Class II patients with a decreased posterior facial height. This paper aims to show a novel modification and its technic description of the conventional BSSO which increases the vertical length of mandibular ramus and angle, in two patients with a similar diagnosis with a one-year follow-up. In conclusion, modified sagittal split osteotomy is the result of the conjunction of two techniques (BSSO and chin wing osteotomy), that is useful in patients who benefit from improvement in the projection of the mandible angle and increase in posterior facial height. Future studies involving long-term follow-up are needed to evaluate the permanence of these results.

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Is Bilateral Sagittal Split Osteotomy of the Mandible With no Step Possible? A Modification in the Technique

Abstract: The mandibular ramus sagittal osteotomy is a usual procedure used to correct deformities of the lower third of the face. Modifications of the procedure will be presented to avoid the presence of palpable gap at mandibular body, easily seen in greater movements.

Cited by 9 publications

References 3 publications

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

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

Effectiveness of low-level laser therapy on recovery from neurosensory disturbance after sagittal split ramus osteotomy: a systematic review and meta-analysis

A modified sagittal split osteotomy: description of technique

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