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. Unilateral sagittal split mandibular ramus osteotomy introduction asymmetry of the face is a threedimensional dentofacial deformity and may involve the maxilla, the mandible, or the chin, or a combination, and its correction may therefore require repositioning of one, two, or all three bones. I was a little nervous in the preop but just wanted to get it over with. However, it can cause neurosensory dysfunction nsd or sensory loss by injury of the inferior alveolar nerve. The duration between osteotomy and oneyear follow up was an average of 12. 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. 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. Three lateral osteotomy designs for bilateral sagittal split. The incidence of transection is reported between 2 to 3. Sagittal split osteotomy definition of sagittal split.
A further search, to verify that all articles had been located, was performed using abbreviated terms such as bsso, sagittal split osteotomy, rif. Le fort osteotomy transverse sectioning and repositioning of the maxilla. Neurosensory disturbance is a common complication of bilateral sagittal split osteotomy bsso. 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 modifications of the sagittal ramus split osteotomy. Effect of sagittal split osteotomy and closing rotation of. The fracture lines and cuts of a bilateral sagittal split osteotomy including the most common unfavourable fractures. A bilateral sagittal split osteotomy technique modification. In this procedure, the osteotomy cut splits the mandibular body and ramus sagittally, so that the fragments can be advanced or set back. Factors affecting the stability of bilateral sagittal split. An unfavourable fracture, known as a bad split, is a common operative complication in bilateral sagittal split osteotomy bsso. 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. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20. 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.
This chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus. 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 lower jaw. 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. Power pdf is flexible enough to serve any industry, yet powerful enough to edit any document. Three different threedimensional finite element models were created, each corresponding to three different fixation methods. Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures.
Mohammad hassan samandari 1, navid naghdi 1 and milad etemadi sh 1 1 department of oral and maxillofacial surgery, school of dentistry, isfahan university of medical sciences, isfahan, iran. The aim of the study was to evaluate the mechanical behavior of three different fixation methods used in the bilateral sagittal split ramus osteotomy. Bilateral sagittal split osteotomy pocket dentistry. C stability of sagittal split ramus osteotomy used to correct. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. Surgical procedures of mandibular sagittal split osteotomy on during mandibular sagittal split osteotomy, the lower jaw is removed. Merge or split pdfs with kofax pdf converter kofax. 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. The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. Furthermore, the study focuses on th e measurement of neurosensory di sturbance with ea sily available. In 7 patients, third molars present in the mandible were removed during surgery. The sagittal split osteotomy obwegeser dal pont bellepker procedure 20.
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. 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. Rating is available when the video has been rented. Lip paresthesia, mandibular prognathism, muscular function, sagittal.
The jaw is split into two sides and then screwed into the desired position. The first osteotomy of the whole mandibular body for the correction of prognathism was performed by blair 2 in 1897. Orthognathic surgery involves correction of patients with skeletal deformities of the mandible and maxilla whether of congenital, developmental, or acquired in origin. The 2 most frequently used techniques are the intraoral vertical ramus osteotomy ivro and the sagittal split ramus osteotomy ssro. 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.
Complications related to mandibular advancement by. C stability of sagittal split ramus osteotomy used to. Ten mandibular plate, screw, hardtissue, and softtissue specimens were taken at 3, 6, 9, or 12 months postoperatively in secondary operations e. Complications of bilateral sagittal split osteotomy in. It can always happen that we will need to add more pages to a pdf document or to remove pages from it at a later point. Skeletal stability after mandibular advancement in. Ensure that you keep your vital records secure while you. 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. Bilateral sagittal split osteotomy bsso is a well documented standardized and relatively safe operation to correct jaw deformities such as mandibular retrognathism. Mandibular osteotomies body osteotomy ostectomy sowrayhaskell modification vertical subsigmoid osteotomy introral ivro extraoral sagittal split osteotomy obwegeserdalpont. The elements of the facial skeleton can be repositioned, redefining the face through a variety of wellestablished osteotomies, including le fort itype osteotomy, le fort iitype osteotomy, le fort iiitype osteotomy, maxillary segmental osteotomies, sagittal split osteotomy of the mandibular ramus, vertical ramal osteotomy, inverted l and c osteotomies, mandibular body segmental. Bilateral sagittal split osteotomy bilateral sagittal split ramus osteotomy bsso is a common mandibular orthognathic procedure.
Incidence of longlasting neurosensory disturbances after. 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. About bilateral sagittal split osteotomy surgery osteotomy is a surgery in which the bone is modified. 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. Stability after bilateral sagittal split osteotomy.
A, obwegesers technique of intraoral sagittal split ostoetomy. 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. Occurrence of bad splits during sagittal split osteotomy. Jan 25, 2014 mandibular osteotomies body osteotomy ostectomy sowrayhaskell modification vertical subsigmoid osteotomy introral ivro extraoral sagittal split osteotomy obwegeserdalpont.
Dec 27, 2018 the elements of the facial skeleton can be repositioned, redefining the face through a variety of wellestablished osteotomies, including le fort itype osteotomy, le fort iitype osteotomy, le fort iiitype osteotomy, maxillary segmental osteotomies, sagittal split osteotomy of the mandibular ramus, vertical ramal osteotomy, inverted l and c osteotomies, mandibular body segmental osteotomies. An osteotomy was performed from the 5 mm above the lingula, moving the saw downwards to 14 mm. Bilateral sagittal split ramus osteotomy bssro is the most widely used mandibular surgical technique in orthognathic surgery and is easy to relocate the distal segments, accelerating bone repair by the large surface of bone contact. Mandibular sagittal split osteotomy orange county surgeons. This study examined two patients exhibiting skeletal class iii malocclusion with facial asymmetry who underwent ussro for a mandibular setback. Biomechanical analysis of titanium fixation plates and screws in sagittal split ramus osteotomies f atik 1, ms atac 2, a ozkan 3, y k. Bilateral sagittal split osteotomy bsso of the mandibular. This osteotomy line should be made just above the lingula and extend posteriorly to it in order to make a safe split, which minimizes the potential for inferior alveolar nerve injury. Anatomic study for the horizontal cut of the sagittal split. Three lateral osteotomy designs for bilateral sagittal. The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks.
Neurosensory disturbance after bilateral sagittal split osteotomy. This study focuses on the evaluation of factors affecting neurosensory disturbance after bsso. Mar 26, 2010 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. Lip paresthesia, mandibular prognathism, muscular function, sagittal split osteotomy. Orthognatic surgery bilateral sagittal split osteotomy on vimeo. One of the most sensitive stages in bsso is recognition of inferior alveolar nerve entrance. Anatomic study for the horizontal cut of the sagittal. There is a higher incidence of inferior alveolar nerve injury with a bilateral sagittal split osteotomy than with a vertical ramus osteotomy when used to set back the mandible. Jun 03, 2016 there is a higher incidence of inferior alveolar nerve injury with a bilateral sagittal split osteotomy than with a vertical ramus osteotomy when used to set back the mandible.
Bilateral sagital split osteotomy is a surgical cosmetic procedure carried out to correct mandibular deformities i. The purpose of this study was to evaluate the mechanical behavior of the mandible and screwminiplate system among three lateral osteotomy designs for. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. 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. Sagittal split mandibular osteotomy definition of sagittal. Oct 07, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 20. The nerve can also be compressed during osteotomy stabilization i. The bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. Assessment of nerve function after mandible surgery with a modified bilateral sagittal split osteotomy technique the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Complications related to mandibular advancement by bilateral. International academy for ultrasonic surgery and implantology 29,144 views. Stability of bilateral sagittal split osteotomy abstract. Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. The historical development of orthognathic surgery has followed a rather stepwise, intermittent course.
Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design. Condylar positioning changes following unilateral sagittal. This technical note presents a noble and safe approach for medial osteotomy in bsso which is based on anatomy of mandible. Jan 08, 2015 in 1953, the sagittal ramus split osteotomy was introduced by obwegeser. Skeletal stability after large mandibular advancement 10. The first mandibular osteotomy is considered to be hullihens 1 procedure in 1849 for the correction of a protruded alveolar mandibular segment. Recovery of inferior alveolar nerve injury after bilateral. Stability of the mandible after bilateral sagittal split. Pdf incidence and recovery of neurosensory disturbances. However, a bilateral sagittal split can be more consistently fixed with plates and screws and hence allows the patient earlier function. Stability of sagittal split ramus osteotomy used to correct class iii 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.
Neurosensory disturbance after bilateral sagittal split. For many years, and in some countries still, this technique has defined the term oral and maxillofacial surgery. Neurosensory disturbances nsds of the lower lip and chin following this procedure are commonly due to lesions of the inferior alveolar. Assessment of nerve function after mandible surgery with a. This study examined two patients exhibiting skeletal class iii malocclusion with facial asymmetry who underwent ussro for a. Oct 16, 2015 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. Computed tomographic analysis of the position and course of the mandibular canal. Mar, 2007 sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Our pdf merger allows you to quickly combine multiple pdf files into one single pdf document, in just a few clicks. B, the dal pont technique sets the cut at the horizontal ramus farther forward, which allows advancements up to 15 mm. A total of 33 consecutive patients underwent bimaxillary surgery to correct skeletal class ii. The basic design of the sagittal ramus split surgical procedure evolved.
Stability of bilateral sagittal split osteotomy bsso is an important goal for every surgeon. Factors affecting the stability of bilateral sagittal. Sorry i didnt post this yesterday, but i wasnt feeling up to it. Original article influence of the design in sagittal split. The patients were divided into two groups according to whether a fixed occlusal splint was used for six weeks group a or dismounted immediately after surgery group b.
Unilateral sagittal split mandibular ramus osteotomy. The mandibles were fixed with double straight 4hole, square 4hole, and 5hole y plates. Biomechanical analysis of titanium fixation plates and. Complications of bilateral sagittal split osteotomy in patients with mandibular prognathism majid eshghpour1, baratolah shaban1, reza shahakbari2, reza mahvelati shamsabadi3, amir hossein nejat4 1 dental research center, department of oral and maxillofacial surgery, faculty of dentistry, mashhad university of medical sciences, mashhad, iran.
Stability of the anterior maxillary segment and teeth after. Skeletal stability after large mandibular advancement. Hunsuck inverted lramus osteotomy variations post condylar grafts 3. Pdf bad split during bilateral sagittal split osteotomy. Nowadays bilateral sagittal split osteotomy bsso is the most common technique for treatment of mandibular skeletal deformities. Biomechanical analysis of titanium fixation plates and screws. Dec 31, 2016 this chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus. Fort i osteotomy alone, or in combination with bilateral sagittal split osteotomy bsso.
This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry. Download fulltext pdf incidence and recovery of neurosensory disturbances after bilateral sagittal split osteotomy in different age groups. The procedure was initially described by hugo obwegeser in 1955 and remains an essential procedure in the plastic and maxillofacial surgeons surgical tool chest. The cut at the outer cortex ends at the gonial angle, which allows rotation, but not large advancements. Stability of the anterior maxillary segment and teeth. Review of the literature setback of the mandible to correct mandibular prognathism is a wellknown procedure.
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