Bilateral sagittal split osteotomies in an ambulatory care. The technique of cutting the mandibular ramus using an extraoral. Complications of bilateral sagittal split osteotomy in. Condylar sag is an immediate or late alteration in the position of the condylar process in the glenoid fossa after the fixation of the osteotomy. Introduction along with great increase in our knowledge over maxillofacial abnormalities and their surgical treatment. The aim of this study is to compare the differences in the stress distributions in the temporomandibular joints tmjs of the patients with facial asymmetry before and after bilateral sagittal split ramus osteotomy bssro under the symmetric occlusions using the threedimensional 3d finite element method ten facial asymmetry patients preoperative group, age 24. Intraoperative computed tomography in bilateral sagittal.
The average clinical followup was 33 months and the average radiological followup with cone beam computerized tomography was. Stability after bilateral sagittal split osteotomy setback surgery with. 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. This study examined two patients exhibiting skeletal class iii malocclusion with facial asymmetry who underwent ussro for a mandibular setback. The authors treated 25 patients who underwent bilateral sagittal split osteotomies due to class ii dentoskeletal deformities. Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Surgical procedures of mandibular sagittal split osteotomy on during mandibular sagittal split osteotomy, the lower jaw is removed. Modified bilateral sagittal split osteotomy for correction. May 06, 2014 bilateral sagittal split ramus osteotomy an orthognathic surgery done at richardson dental and craniofacial hospital, nagercoil, tamilnadu, india.
This allows the front part of the mandible to slide backward or forward until the teeth are aligned. Translation find a translation for bilateral saggital split osteotomy jaw surgery in other languages. Threedimensional evaluation of lingual split line after. This article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. 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. It was first described by trauner and obwegeser in 1957. The bone on the sagittal or side of the lower mandible of the jaw is cut on each side to form a split. Onestage technique for sagittal split ramus osteotomy combined. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Objectives the objective of the study was to show the importance of intraoperative computed tomography as an aid for ensuring inferior alveolar nerve safety during bilateral sagittal split osteotomy. Three lateral osteotomy designs for bilateral sagittal split osteotomy. These modifications include the technique described by dal pont 3.
This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry. Stability of hard tissue profile after mandibular setback. Complications of bilateral sagittal split osteotomy in patients with mandibular prognathism. Relative macroglossia, mandibular prognathism, mandibular setback surgery, bilateral sagittal split osteotomy 1. For advancement of the retrognathic mandible, bilateral sagittal split osteot omy bsso is the most frequently used surgical technique. Sagittal split osteotomy sso is a common surgical technique for correcting lower jaw deformities, which is either done as unilateral sagittal split osteotomy usso or bilateral sagittal split. At this time, the upper jaw can be moved and aligned. However, several disadvantages, such as fracture, bleeding, infection, and tmd, were found after bilateral sagittal split ramus osteotomy bssro. The mandibular osteotomy site defects 815 mm were augmented with bioactive glass s53p4. 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. Threedimensional evaluation of lingual split line after bilateral sagittal split osteotomy in asymmetric prognathism. The mandibular ramus sagittal osteotomy is a usual procedure used to correct deformities of the lowe. Since then, several modifications of the technique have been introduced with the aim of improving surgical convenience, minimizing morbidity, and maximizing procedural stability. 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. Ramus osteotomy ivsro, intergonial width, mandibular prognathism, inter ramal angle 1. Recovery of inferior alveolar nerve injury after bilateral. Studies have proven the sagittal split osteotomy can be performed as an ambulatory procedure. Distraction osteogenesis versus bilateral sagittal split osteotomy for. The influence of bilateral sagittal split ramus osteotomy. Le fort osteotomy transverse sectioning and repositioning of the maxilla. The purpose of this study was to evaluate the mechanical behavior of the mandible and screwminiplate system among three lateral osteotomy designs for.
Bilateral sagittal split osteotomy bsso is a widely used orthognathic surgical technique. Sagittal split osteotomy sso was described by obwegeser et al in 19551 for the correction of both prognathism and mandibular deficiency. Is bilateral sagittal split osteotomy of the mandible with n. 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 bones will be moved like in this illustration, and theyll use titanium plates to fill in the gaps. The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks. In subsequent years, several modifications have been described. The purpose of this prospective observational study was to evaluate whether cone beam ct cbct is a useful tool for analyzing the fracture line in a bilateral sagittal split osteotomy bsso. Changes of transverse mandibular width in setback mandibular.
All patients were satisfied with the outcome of the procedure. Introduction mandibular setback surgery using a bilateral sagittal split osteotomy bsso has routinely been used as an orthognathic surgical procedure for mandibular prognathism 1. Oct 07, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 20. This osteotomy technique originally was described by trauner and obwegeser in 1957. Bilateral sagittal split osteotomy jefferson university. Nowadays bilateral sagittal split osteotomy bsso is the most common technique for treatment of mandibular skeletal deformities. Mar, 2007 sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Bilateral sagittal split osteotomy pubmed central pmc. Incidence of longlasting neurosensory disturbances after. The bilateral sagittal split mandibular ramus osteotomy. Macroglossia is defined as tongue enlargement due to muscle hypertrophy, tumor or an endocrine disturbance. It is performed to correct types of malocclusion, a misalignment of teeth. Stability after bilateral sagittal split osteotomy. A patient with mandibular hypoplasia and angles class ii malocclusion presented for a bilateral sagittal split osteotomy and genioplasty with genial tubercle advancement.
Modified bilateral sagittal split osteotomy for correction of. Condylar positioning changes following unilateral sagittal. Mandibular sagittal split ramus osteotomy is the most common mandibular orthognathic procedure. Sagittal split osteotomy definition of sagittal split. Bsso bilateral saggital split osteotomy jaw surgery. Modification of the mandibular split based on a physical model. Mandibular sagittal split osteotomy orange county surgeons.
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. In this article we describe a rare case of pseudoaneurysm developing over 4 weeks after an uneventful le fort i maxillary osteotomy, sagittal split osteotomy, and advancement genioplasty. Pdf most of the skeletal malocclusions which require orthognathic surgeries are treated by traditional approach which requires timeconsuming and. Bilateral mandibular sagittal split osteotomy advancement. This technical note presents a noble and safe approach for medial osteotomy in bsso which is based on anatomy of mandible. 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.
The jaw is split into two sides and then screwed into the desired position. Mandibular setback surgery using a bilateral sagittal split osteotomy bsso has routinely been used as an orthognathic surgical procedure for mandibular prognathism 1. Lefort 1 osteotomy possible segmental and bilateral mandibular sagittal split osteotomy advancement what a mouthful. Bilateral sagittal split osteotomy bilateral sagittal split ramus osteotomy bsso is a common mandibular orthognathic procedure. Unilateral sagittal split mandibular ramus osteotomy. Bilateral sagittal split ramus osteotomy an orthognathic surgery done at richardson dental and craniofacial hospital, nagercoil, tamilnadu, india.
Faculty of dental medicine alazhar universityorthognathic surgery is the bilateral sagittal split osteotomy bsso has a wide range of. Neurosensory deficits after bilateral sagittal split osteotomy of the mandibleinfluence of sort tissue handling medial to the ascending 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. Bilateral sagittal split ramus osteotomy bssro is commonly used to correct. Maxilla osteotomy upper jaw this procedure is intended for patients with an upper jaw deformity, or with an open bite. Surgical lengthening using a bilateral sagittal split osteotomy bsso of the mandible is the most often executed orthognathic procedure in western europe. A 22yearold man presented with a severe class iii skeletal deformity, mandibular hyperplasia, and maxillary hypoplasia. Modification of the bilateral sagittal split osteotomy bsso in a study. Apr 25, 2020 a sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. Modified bilateral sagittal split osteotomy for correction of severe anterior open bite.
Operating on the upper jaw requires surgeons to make incisions below both eye sockets, making it a bilateral osteotomy, enabling the whole upper jaw, along with the roof of the mouth and upper teeth, to move as one unit. To evaluate a method to identify condylar sag intraoperatively by clinical examination after bilateral sagittal split osteotomy bsso. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. Computed tomographic analysis of the position and course of the mandibular canal. Pseudoaneurysm of the facial artery as a late complication. Three lateral osteotomy designs for bilateral sagittal split. This study examined two patients exhibiting skeletal class iii malocclusion with facial asymmetry who underwent ussro for a. Condylar sag is an immediate or late alteration in the position of the condylar process in the. Monson, md1 surgery, baylor college of medicine, houston, texas semin plast surg 20. Correlation between lingual split line pattern and the position of the lateral bone cut end group type i type ii type iiia type iiib type iv total type a.
Subjective alveolar nerve function after bilateral sagittal. Subjective alveolar nerve function after bilateral. The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. A new hybrid technique for performing a safer bilateral sagittal. One of the most sensitive stages in bsso is recognition of inferior alveolar nerve entrance. A sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. The bilateral sagittal split osteotomy is evaluated as an ambulatory surgical procedure. Mandibular osteotomies in orthognathic surgery of face. Bilateral sagittal split osteotomy description of surgical technique to complement the procedural cognition simulation in the craniofacial interactive virtual assistantprofessional edition.
Bilateral sagittal split ramus osteotomy introduced by trauner and obwegeser has usually been used to correct facial asymmetry. Oral and maxillofacial surgeons at jefferson are among the best in the delaware valley in performing a bilateral sagittal split osteotomy. Lefort 1 osteotomy during this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. Osteotomy site grafting in bilateral sagittal split surgery. Osteotomy of the mandibular ramus by bilateral sagittal split ramus osteotomy bssro, which was first introduced by trauner and obwegeser in 1957, is widely used to correct mandibular prognathism and retrognathism 1. Introduction along with great increase in our knowledge over maxillofacial abnormalities and their surgical treatment during the recent decades, mandibular osteotomy. Bilateral sagittal split osteotomy for mandibular setback in combination with orthodontics is an effective treatment of skeletal class iii and a stable procedure in.
Neurosensory disturbance after bilateral sagittal split osteotomy. Trauner and obwegeser 1 were the first to describe this procedure in 1957. This surgery involves advancing the lower jaw to correct the overbite. Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design. Jan 23, 2017 this article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. Assessment of nerve function after mandible surgery with a. Relationship of the mandibular canal to the lateral cortex of the mandibular ramus as a factor in the development of neurosensory disturbance after bilateral sagittal split osteotomy. Three lateral osteotomy designs for bilateral sagittal. However, it can cause neurosensory dysfunction nsd or sensory loss by injury of the inferior alveolar nerve. Also, hes supposed to be on a liquidsoft food diet for six weeks. 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.
Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures. Osteotomy site grafting in bilateral sagittal split. 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. Jan 22, 2018 sagittal split osteotomy a surgical procedure resembling the saggital split osteotomy was described in 1942 in the german literature by schuchardt. 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. Pdf the technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with. The aim of the study was to conduct a longterm followup on the stability of the hard tissues after bilateral sagittal split osteotomy bsso with rigid internal fixation rifto set back the mandible and to compare it with that of mandibular advancement performed by the same team of surgeons and with the same examination protocol. Lane evidently described a similar procedure earlier, which was done extraorally. Anything you did to deal with it or anything people could have done to make it easier for you would be greatly appreciated. Ramus thickness level of mandibular lingula mm gender n deviated side contralateral side pvalue male 20 female 20 total 40 7.
The technique has undergone numerous modifications. My brother is about to undergo a bilateral sagittal split osteotomy. 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. I was wondering if anyone has had this surgery and has any helpful tips for the recovery process.
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