Occurrence of bad splits during sagittal split osteotomy

Falter, Bart; Schepers, Serge; Vrielinck, Luc; Lambrichts, Ivo; Thijs, Herbert; Politis, Constantinus

doi:10.1016/j.tripleo.2010.02.003

Cited by 66 publications

(16 citation statements)

References 14 publications

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“…The incidence of mental nerve deficit during genioplasty is 20% while a combined procedure of genioplasty and sagittal split osteotomy (SSO) increases the chances of sensory deficit to almost 70%. [25]…”

Section: During Treatmentmentioning

confidence: 99%

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Unfavourable outcomes in orthognathic surgery

Bonanthaya¹,

Anantanarayanan²

2013

Indian J Plast Surg

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Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

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Section: During Treatmentmentioning

confidence: 99%

“…The chances for a bad fracture is more common in a lefort 1 osteotomy when the conventional lines are modified to include the infra-orbital rim or zygoma where the osteotomy may have to be blind behind the zygoma. [25]…”

Section: During Treatmentmentioning

confidence: 99%

Unfavourable outcomes in orthognathic surgery

Bonanthaya¹,

Anantanarayanan²

2013

Indian J Plast Surg

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“…The incidence ranges from 0.5% to 5.4%8. Mehra et al4 reported a 1.4% incidence of unfavorable lingual fracture (mostly in cases of impacted third molar of the mandible) and a 0.8% incidence of buccal fracture of the proximal segment.…”

Section: Introductionmentioning

confidence: 99%

“…Unexpected fracture or split with buccal fracture of the proximal segment and lingual fracture of the distal segment during SSRO is one of the most common complications6-8. The incidence ranges from 0.5% to 5.4%8.…”

Section: Introductionmentioning

confidence: 99%

Effect of perioperative buccal fracture of the proximal segment on postoperative stability after sagittal split ramus osteotomy

Lee

Yang

Han

et al. 2013

J Korean Assoc Oral Maxillofac Surg

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ObjectivesBuccal fracture of the mandibular proximal bone segment during bilateral sagittal split ramus osteotomy (SSRO) reduces the postoperative stability. The primary aim of this study is to evaluate the effect of this type of fracture on bone healing and postoperative stability after mandibular setback surgery.Materials and MethodsTen patients who experienced buccal fracture during SSRO for mandibular setback movement were evaluated. We measured the amount of bone generation on a computed tomography scan, using an image analysis program, and compared the buccal fracture side to the opposite side in each patient. To investigate the effect on postoperative stability, we measured the postoperative relapse in lateral cephalograms, immediately following and six months after the surgery. The control group consisted of ten randomly-selected patients having a similar amount of set-back without buccal fracture.ResultsLess bone generation was observed on the buccal fracture side compared with the opposite side (P<0.05). However, there was no significant difference in anterior-posterior postoperative relapse between the group with buccal fracture and the control group. The increased mandibular plane angle and anterior facial height after the surgery in the group with buccal fracture manifested as a postoperative clockwise rotation of the mandible.ConclusionBone generation was delayed compared to the opposite side. However, postoperative stability in the anterior-posterior direction could be maintained with rigid fixation.

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“…When an unfavorable fracture does occur, it is reported that operating time and technical difficulty are increased in the operation theater while in the postoperative period, local infection, nonunion, mal-union, prolonged neurologic symptoms, and enhanced chance of relapse occur more often after such an unfavorable fracture. [78]…”

Section: Introductionmentioning

confidence: 99%

Impacted third molars in sagittal split osteotomies in mandibular prognathism and micrognathia

Balaji

2014

Ann Maxillofac Surg

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Background:The timing of removal of mandibular third molars (M3) in Sagittal Split Osteotomy (SSO) has been an issue of contention. The aim of this retrospective study is to identify the incidence of unfavorable fractures during SSO with the presence of M3 and to identify the association between unfavorable fractures with the factors specifically related to the M3.Materials and Methods:Retrospective analysis of consecutive bilateral sagittal split osteotomy (BSSO) patient's treatment records of 208 patients treated by a single surgeon was analyzed. The position of M3, fracture details, and demographics were collected. Descriptive statistics and Chi-square tests were employed in SPSS package. A P ≤ 0.05 was taken as significant.Results:There were altogether 416 SSO performed. M3 was completely impacted in 88.9% of all instances, and in 85.6% of the instances, the bulk of the M3 was identified to be above the external oblique ridge. In 59.4% of the cases, M3 was positioned in alignment with the arch as observed during surgery. There were about 27 (6.5%) instances of unfavorable splits. A statistically significant relationship was observed with M3 root morphology and axial position of M3.Discussion:This study for the first time has confirmed the spatial positioning of M3 as one of the several causes of unfavorable splits during SSO. An impacted M3 that lies below the oblique ridge, distoangularly/vertically oriented, with divergent/supernumerary root would cause unfavorable splits when the spreader is not used properly. Potential causes and influencing factors of the unfavorable splits are discussed.

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Occurrence of bad splits during sagittal split osteotomy

Cited by 66 publications

References 14 publications

Unfavourable outcomes in orthognathic surgery

Unfavourable outcomes in orthognathic surgery

Effect of perioperative buccal fracture of the proximal segment on postoperative stability after sagittal split ramus osteotomy

Impacted third molars in sagittal split osteotomies in mandibular prognathism and micrognathia

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