The sagittal split osteotomy obwegeserdal pont bellepker procedure 6. This study focuses on the evaluation of factors affecting neurosensory disturbance after bsso. Orthognathic jaw surgery is a reconstructive procedure and medically necessary and is considered covered when both the skeletal deformity and the functional im pairment criteria below are met. Neurosensory disturbances nsds of the lower lip and chin following this procedure are commonly due to lesions of the inferior alveolar nerve and its terminal branch, the. The ramus sagittal split osteotomy or mandibular body is an established technique for correction of dentofacial deformities but can have an accurate indication in cases requiring surgical access. This animation shows the results of a sagittal split osteotomy surgical procedure in which the mandible is moved into a more benefical position for the patient. A new technique for mandibular osteotomy springerlink. The sagittal split osteotomy sso may prove to be a useful extraction method of deeply impacted mandibular molars due to its controlled manner of removing bone and its reduction of the risk of alveolar nerve damage via the direct identification of anatomic structures. Neurosensory disturbance is a common complication of bilateral sagittal split osteotomy bsso. Le fort osteotomy transverse sectioning and repositioning of the maxilla. The authors treated 25 patients who underwent bilateral sagittal split osteotomies due to class ii dentoskeletal deformities. Twelve sagittal split osteotomies were fixed with 12 macrosorb plates in six patients, and 24 osteotomies were filled with 32 polymax plates in 12 patients. C stability of sagittal split ramus osteotomy used to. Bilateral sagittal split osteotomy of mandible bsso is a surgical method used to correct the sagittal, transversal and vertical position of the lower jaw.
Risk factors for common complications associated with bilateral sagittal split osteotomy. Osteotomy site grafting in bilateral sagittal split. Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures. Assessment of nerve function after mandible surgery with a. The modifications of the sagittal ramus split osteotomy. About bilateral sagittal split osteotomy surgery osteotomy is a surgery in which the bone is modified. Lefort 1 osteotomy during this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. 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. To determine intraoperative as well as post surgical complications of bilateral sagittal split ramus osteotomy. Effect of sagittal split osteotomy and closing rotation of. Surgical correction of skeletal openbite by lefort 1 maxillary osteotomy and mandibular sagittal split osteotomy.
Three lateral osteotomy designs for bilateral sagittal. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. Cleanup and merge sculpt away any excess tissue from around the maxilla and mandible, and replace lowresolution cbct teeth with automerged. Impacted third molars in sagittal split osteotomies in. The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone contact between the segments, and possibilities of osteosynthesis.
Neurosensory disturbance after bilateral sagittal split. The bone on the sagittal or side of the lower mandible of the jaw is cut on each side to form a split. Lip paresthesia, mandibular prognathism, muscular function, sagittal. Complications related to mandibular advancement by. The sagittal split osteotomy sso of rami with fused or no marrow space above the lingula may increase the risk for an unfavorable osteotomy split of the proximal ramus. The nerve can also be compressed during osteotomy stabilization i. Surgical correction of skeletal openbite by lefort 1. Sagittal splitting of mandible definition of sagittal. The average clinical followup was 33 months and the average radiological followup with cone beam computerized tomography was. Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. This allows the front part of the mandible to slide backward or forward until the teeth are aligned.
Among the techniques used in correction surgeries of the mandible, the sagittal split ramus osteotomy ssro of the mandibular ramus is still the most frequently performed. Bilateral sagittal split ramus osteotomy an orthognathic surgery done at richardson dental and craniofacial hospital, nagercoil, tamilnadu, india. The low medial horizontal osteotomy in patients with. Patients and methods a retrospective evaluation of 44 case records of bssro, performed over a period of five years from january 2010 to dec 2014, at a single center. During sagittal split ramus osteotomies of the mandible, the inferior alveolar nerve can be directly damaged by a burr on a rotary drill, a blade on a reciprocating saw, or a chisel used to complete the split. A bilateral sagittal split osteotomy technique modification.
The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. This procedure is versatile and can be used to achieve mandibular movements that include forward and backward sliding osteotomies, as well as corrective surgery for mandibular asymmetries. Review of the literature setback of the mandible to correct mandibular prognathism is a wellknown procedure. The mandibular osteotomy site defects 815 mm were augmented with bioactive glass s53p4. The technique has been in practice since the late 1800s, but did not reach widespread acceptance and use until several modifications were described in the 1960s and 1970s. A bilateral sagittal split osteotomy is a type of jaw surgery in which the lower jaw mandible is split bilaterally moved forward or backward to straighten it to a more balanced and functional position. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. Condylar positioning changes following unilateral sagittal. Sagittal split osteotomy recommended optional univr u le fort i osteotomy u chin osteotomy orthognatic u maxillofacial surgery u condilectomy eminectomy u mandibular angle ostectomy recommended mt2r4 mt2l4 u recommended mt1s10 u rhinoplasty percutaneous approach. Pdf risk factors for common complications associated. To reduce the risk of a proximal segment fracture, a recent modification of the sso places the medial horizontal osteotomy below the lingula.
A sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. Sagittal split osteotomy and mandibular advancement. Bilateral sagittal split osteotomy bilateral sagittal split ramus osteotomy bsso is a common mandibular orthognathic procedure. A bsso is performed on the lower jaw, the mandible, in order to move it forward in the case of a deficient lower jaw, or backward in the case of a large. Computed tomographic analysis of the position and course of the mandibular canal. Bilateral sagittal split osteotomy bsso is a well documented standardized and relatively safe operation to correct jaw deformities such as mandibular retrognathism. Originally developed in the middle of the last century by hugo obwegeser, at the department of surgery, medical university of graz, austria, the technique quickly found its way into the armamentarium of surgical procedures in orthognathic surgery. Borstlap and others published the fixation of sagittal split osteotomies with miniplates find, read and cite all the research you need on researchgate. An in vitro comparison between two different designs of. Furthermore, the study focuses on th e measurement of neurosensory di sturbance with ea sily available. The timing of removal of mandibular third molars m3 in sagittal split osteotomy sso has been an issue of contention.
Bilateral sagittal split osteotomy jefferson university. This article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. The bilateral sagittal split osteotomy bsso, described as early as in 1957, is the most frequently used procedure to correct mandibular skeletal discrepancies by lengthening or shortening the mandible. Surgical procedures of mandibular sagittal split osteotomy on during mandibular sagittal split osteotomy, the lower jaw is removed. A sagittal split ramus osteotomy ssro was designed in 10 hemimandibles group 1 with a vertical osteotomy in the buccal side second molar level and final osteotomy was performed horizontally on the lingual aspect, while the mandible body osteotomy was finalized as a straight osteotomy in the basilar area, perpendicular to the body. Bilateral sagittal split osteotomy, 241, 257 bispectral analysis bis, 627 branchial cyst excision, 431, 434 c central compartment neck dissection and superior mediastinal dissection, 333 cervicofacial rotationadvancement flap, 200, 204 cervicothoracic neurofibroma, 559 cheek and alar defect, vy advancement flap, 235, 239 coblation, 636. The surgical procedure consists of bilateral osteotomies of the mandible, in which the angulus area is exposed by intraoral incisions and split in a near sagittal plane on both sides. Anatomic study for the horizontal cut of the sagittal. Then, sagittal cut was doing it through the lateral area of the second molar and between the two molars, the osteotomy descended perpendicularly to the basilar border, including the medial area of the mandible figure 1. Sagittal split osteotomy definition of sagittal split.
The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks. The procedure was initially described by hugo obwegeser in 1955 and remains an essential procedure in the plastic and maxillofacial surgeons surgical tool chest. Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design. Midline osteotomy path for sagittal split osteotomy bsso and genioplasty bottom view vertical ramus osteotomy sagittal split osteotomy. Lefort 1 osteotomy possible segmental and bilateral mandibular sagittal split osteotomy advancement what a mouthful. This study examined two patients exhibiting skeletal class iii malocclusion with facial asymmetry who underwent ussro for a. Faculty of dental medicine alazhar universityorthognathic surgery is the bilateral sagittal split osteotomy bsso has a wide range of. The 2 most frequently used techniques are the intraoral vertical ramus osteotomy ivro and the sagittal split ramus osteotomy ssro. Since 1957, when it was introduced by trauner and obwegeser 1, 2, 3, it has undergone a number of modifications in surgical technique as well as fixation of the segments.
This chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus. However, the traditional design of buccal osteotomy, located at the junction of mandibular ramus and body, may prevent more extensive sliding between the bone segments, particularly on the advance, laterality and verticality of the mandibular body. Mandibular sagittal split osteotomy orange county surgeons. An osteotomy was performed from the 5 mm above the lingula, moving the saw downwards to 14 mm.
Incidence of longlasting neurosensory disturbances after. Original article influence of the design in sagittal split. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Ten mandibular plate, screw, hardtissue, and softtissue specimens were taken at 3, 6, 9, or 12 months postoperatively in secondary operations e. Stability of sagittal split ramus osteotomy used to correct class iii malocclusion.
The location of the lateral osteotomy cut during bilateral sagittal split osteotomy bsso varies according to the surgeons preference, and no consensus has been reached regarding the ideal location from the perspective of biomechanics. It is performed to correct types of malocclusion, a misalignment of teeth. This study was performed to evaluate threedimensional positional change of the condyle using threedimensional computed tomography 3dct following unilateral sagittal split ramus osteotomy ussro in patients with mandibular prognathism. The presence of any of the following facial skeletal deformities associated with masticatory malocclusion. Several technical modifications based on the anatomical position of the neurovascular bundle and its bony mandibular canal have been developed, aiming to prevent injury to the intraalveolar nerve we hypothesized that the incidence of neurosensory disturbance nsd should be reduced using our bilateral sagittal split osteotomy bsso technique, because direct intraalveolar nerve injury can be. The purpose of this study was to evaluate the mechanical behavior of the mandible and screwminiplate system among three lateral osteotomy designs for.
This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry. In 1953, the sagittal split osteotomy evolved into a procedure that could be accomplished intraorally, without transfacial approaches and without leaving visible scars. The bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. Removal of deeply impacted mandibular molars by sagittal. The jaw is split into two sides and then screwed into the desired position. A bilateral sagittal split osteotomy is performed by oral and maxillofacial surgeons to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth, which, in turn, can improve chewing. This technique provides a large area of contact between the bone fragments, improving surgical stability and bone healing, as well as the possibility of rigid internal.
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