Original article influence of the design in sagittal split. To reduce the risk of a proximal segment fracture, a recent modification of the sso places the medial horizontal osteotomy below the lingula. The presence of any of the following facial skeletal deformities associated with masticatory malocclusion. An in vitro comparison between two different designs of.
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. This study examined two patients exhibiting skeletal class iii malocclusion with facial asymmetry who underwent ussro for a. Anatomic study for the horizontal cut of the sagittal. 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. The timing of removal of mandibular third molars m3 in sagittal split osteotomy sso has been an issue of contention. 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. 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. The jaw is split into two sides and then screwed into the desired position. The nerve can also be compressed during osteotomy stabilization i.
The procedure was initially described by hugo obwegeser in 1955 and remains an essential procedure in the plastic and maxillofacial surgeons surgical tool chest. This allows the front part of the mandible to slide backward or forward until the teeth are aligned. Borstlap and others published the fixation of sagittal split osteotomies with miniplates find, read and cite all the research you need on researchgate. 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. Incidence of longlasting neurosensory disturbances after. Ten mandibular plate, screw, hardtissue, and softtissue specimens were taken at 3, 6, 9, or 12 months postoperatively in secondary operations e. This study focuses on the evaluation of factors affecting neurosensory disturbance after bsso. Selection of sagittal split ramus osteotomy technique. A sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry. Minimally invasive aesthetic and functional jaw surgery. Sagittal split osteotomy definition of sagittal split. 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.
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, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks. Mandibular sagittal split osteotomy orange county surgeons. Computed tomographic analysis of the position and course of the mandibular canal. This chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus.
Faculty of dental medicine alazhar universityorthognathic surgery is the bilateral sagittal split osteotomy bsso has a wide range of. Bilateral sagittal split osteotomy bsso is a well documented standardized and relatively safe operation to correct jaw deformities such as mandibular retrognathism. 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. 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. 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. Surgical procedures of mandibular sagittal split osteotomy on during mandibular sagittal split osteotomy, the lower jaw is removed. Lefort 1 osteotomy during this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. The bilateral sagittal split osteotomy bsso can be considered a milestone in surgery in general. 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. 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. Removal of deeply impacted mandibular molars by sagittal.
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. Sagittal splitting of mandible definition of sagittal. The modifications of the sagittal ramus split osteotomy. Surgical correction of skeletal openbite by lefort 1 maxillary osteotomy and mandibular sagittal split osteotomy. 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. A new technique for mandibular osteotomy springerlink. Stability of sagittal split ramus osteotomy used to correct class iii malocclusion. Neurosensory disturbance after bilateral sagittal split. The purpose of this study was to evaluate the mechanical behavior of the mandible and screwminiplate system among three lateral osteotomy designs for. 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. Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. The average clinical followup was 33 months and the average radiological followup with cone beam computerized tomography was.
Sagittal split osteotomy and mandibular advancement. Bilateral sagittal split osteotomy jefferson university. The low medial horizontal osteotomy in patients with. 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. 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. 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. Surgical correction of skeletal openbite by lefort 1. The bilateral sagittal split mandibular ramus osteotomy. The sagittal split osteotomy obwegeserdal pont bellepker procedure 6. 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. Assessment of nerve function after mandible surgery with a. Factors affecting the stability of bilateral sagittal. C stability of sagittal split ramus osteotomy used to. 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. An osteotomy was performed from the 5 mm above the lingula, moving the saw downwards to 14 mm. Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures. 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 fixation of sagittal split osteotomies with miniplates. Effect of sagittal split osteotomy and closing rotation of. 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. Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design. 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.
Furthermore, the study focuses on th e measurement of neurosensory di sturbance with ea sily available. Midline osteotomy path for sagittal split osteotomy bsso and genioplasty bottom view vertical ramus osteotomy sagittal split osteotomy. 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. 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. 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.
Pdf risk factors for common complications associated. Review of the literature setback of the mandible to correct mandibular prognathism is a wellknown procedure. Bilateral sagittal split ramus osteotomy an orthognathic surgery done at richardson dental and craniofacial hospital, nagercoil, tamilnadu, india. Bilateral sagittal split osteotomy of mandible bsso is a surgical method used to correct the sagittal, transversal and vertical position of the lower jaw. 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. Complications related to mandibular advancement by. 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. Cleanup and merge sculpt away any excess tissue from around the maxilla and mandible, and replace lowresolution cbct teeth with automerged. 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. The mandibular osteotomy site defects 815 mm were augmented with bioactive glass s53p4. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. Risk factors for common complications associated with bilateral sagittal split osteotomy.
Le fort osteotomy transverse sectioning and repositioning of the maxilla. Bilateral sagittal split osteotomy bilateral sagittal split ramus osteotomy bsso is a common mandibular orthognathic procedure. The bone on the sagittal or side of the lower mandible of the jaw is cut on each side to form a split. Complications of bilateral sagittal split osteotomy in. To determine intraoperative as well as post surgical complications of bilateral sagittal split ramus osteotomy. Lip paresthesia, mandibular prognathism, muscular function, sagittal. The 2 most frequently used techniques are the intraoral vertical ramus osteotomy ivro and the sagittal split ramus osteotomy ssro. 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. Lefort 1 osteotomy possible segmental and bilateral mandibular sagittal split osteotomy advancement what a mouthful. Impacted third molars in sagittal split osteotomies in. Osteotomy site grafting in bilateral sagittal split. The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. About bilateral sagittal split osteotomy surgery osteotomy is a surgery in which the bone is modified. A bilateral sagittal split osteotomy technique modification.
It is performed to correct types of malocclusion, a misalignment of teeth. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. 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. Neurosensory disturbance is a common complication of bilateral sagittal split osteotomy bsso. Condylar positioning changes following unilateral sagittal. Three lateral osteotomy designs for bilateral sagittal. 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.
1324 988 48 517 1080 295 135 895 939 542 876 677 1477 567 739 1488 1548 465 904 396 434 442 641 1085 1233 528 1585 40 1061 261 4 13 408 980 887 1052 565 620 705 327 13 250