A in the traunerobwegeser to method, the lateral osteotomy cut was made horizontally from the distal region of the second molar to the posterior border well above the mandibular angle. A retrospective cohort of 56 patients with conventional miniplate repositioned mandibles was also collected for statistical analysis. Impacted third molars in sagittal split osteotomies in. Complications related to mandibular advancement by bilateral. Jul 16, 2012 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. 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. Application of 3d printing technique in bilateral sagittal split. The technique has undergone numerous modifications. Thereafter, a sagittal split of the body of the mandible is performed as usual technique and the. Looking for online definition of sagittal split osteotomy in the medical dictionary. A new technique for mandibular osteotomy springerlink.
Mandibular first and second molars do not share the same frequency of occurrence. Bilateral sagittal split ramus osteotomy bssro has the same disadvantages while unilateral sagittal split ramus osteotomy ussro has the advantage of being less invasive and having fewer complications. In addition, patient operative charts were studied for any information on the occurrence of an unfavorable split during osteotomy. Mandibular sagittal split ramus osteotomy is the most common mandibular orthognathic procedure. The bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. Presence of mandibular third molars during bilateral sagittal split osteotomy. Sagittal split osteotomy definition of sagittal split. Nadiras bilateral sagittal split osteotomy history. Sagittal split osteotomy was carried out virtually, and the fixation techniques were applied onto the model. Nowadays, it is widely acknowledged that people in korea, japan, and china prefer an oval face, the lower part of which is slender.
The ability to rigidly and properly fix the fractured segments at the time of surgery may facilitate healing in the immediate postoperative period and reduce the displacement possibility of the bony segments, particularly the condylar proximal segment 27. Our surgical technique was therefore changed several years ago by stripping the medial pterygoid muscles also for mandibular advancement procedures. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy. However, the traditional design of buccal osteotomy, located at the junction of. The basic design of the sagittal ramus split surgical procedure evolved very quickly. Dec 31, 2016 orthognathic surgery involves correction of patients with skeletal deformities of the mandible and maxilla whether of congenital, developmental, or acquired in origin. Choose from 6 mandibular sagittal split osteotomy clinics in central singapore. Select a plate shape that best suits the bony anatomy, treatment objective, and the quantity and quality of bone. It is done to either move the lower jaw and its attached teeth either forward or back to correct dentoalveolar deformities and bring the teeth into a better interdigitating relationship.
Bilateral sagittal split osteotomy bsso is a widely used orthognathic surgical technique. The purpose of this study was to evaluate the mechanical behavior of the mandible and screwminiplate system among three lateral osteotomy designs for bsso by. This chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus. The original description of the bilateral sagittal split osteotomy bsso is credited to trauner and obwegeser. Modified mandibular sagittal split osteotomy request pdf. Medial pterygoid muscle attachment overlying sagittal split osteotomy line on the medial aspect of the mandibular ramus. In some cases, a supernumerary fourth molar can be seen as unerupted and, in. Mandibular setback surgery using a bilateral sagittal split osteotomy bsso has routinely been used as an orthognathic surgical procedure for mandibular prognathism 1. The sagittal split mandibular ramus osteotomy ssro is the most commonly performed osteotomy of the mandible. For many years, and in some countries still, this technique has defined the term oral and maxillofacial surgery. The original sagittal split described by obwegeser takes the horizontal osteotomy through the full anteriorposterior dimension of the ramus fig.
Only the bony cortex on the lingual side is cut at approximately 1 cm in length. Bilateral sagittal split osteotomy pocket dentistry. C stability of sagittal split ramus osteotomy used to correct. Computerassisted teaching of bilateral sagittal split osteotomy plos. Review of the literature setback of the mandible to correct mandibular prognathism is a wellknown procedure. This procedure is versatile and can be used to achieve mandibular movements that include forward and backward sliding osteotomies, as well. Lefort 1 osteotomy during this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. 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. Oct 07, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Three lateral osteotomy designs for bilateral sagittal. All of these disadvantages were solved by the sagittal split osteotomy revolutionary for the time, and which was first tested in an edentulous patient under sedation and local anesthesia in february 1953 fig. Variacion petersons principles of oral and maxillofacial surgery second edition.
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. An unfavourable fracture, known as a bad split, is a common operative complication in bilateral sagittal split osteotomy bsso. Original article photoelastic evaluation of two different sagittal split ramus osteotomies in advancement surgery valdir cabral andrade 1, sergio olate2,3, leandro pozzer. Special emphasis is given to different types of fixation of bone fragments. The sagittal split ramus osteotomy ssro is an established technique in orthognatic surgery. In the majority of cases, this technique allows for adequate splitting of the mandible. 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. Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design.
Mohammad hassan samandari1, navid naghdi1 and milad etemadi sh1 1department of oral and maxillofacial surgery, school of dentistry, isfahan university of medical sciences, isfahan, iran. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. Introduction along with great increase in our knowledge over maxillofacial abnormalities and their surgical treatment during the recent decades, mandibular osteotomy. A finite element analysis study comparing 3 internal. This article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. Orthognathic surgery is a well established and widely used treatment option for insufficient growth of the maxilla in patients with an orofacial cleft. Complications related to mandibular advancement by bilateral sagittal split osteotomy. Bilateral sagittal split mandibular ramus osteotomy. Factors affecting the stability of bilateral sagittal split. Procedure for sagittal splitting and mandibular angle ostectomy. International academy for ultrasonic surgery and implantology 29,144 views. The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks. Sagittal split mandibular osteotomy definition of sagittal.
How to split a pdf file adobe acrobat dc tutorials adobe support. Mandibular third molars are the most common impacted teeth. All relevant data are within the paper and its supporting information files. Threedimensional evaluation of lingual split line after bilateral sagittal split osteotomy in asymmetric prognathism jae min song, yong deok kim department of oral and maxillofacial surgery, school of dentistry, pusan national university, yangsan, korea abstract. Most maxillofacial surgeons use an intuitive repositioning technique. This osteotomy technique originally was described by trauner and obwegeser in 1957. Schematic of the three lateral osteotomy designs for bilateral sagittal split osteotomy bsso. Faculty of dental medicine alazhar universityorthognathic surgery is the bilateral sagittal split osteotomy bsso has a wide range of.
A guiding oblique osteotomy cut to prevent bad split in sagittal split. A bilateral sagittal split osteotomy bsso is a procedure used frequently for the correction of a class ii malocclusion. Below are the links to the authors original submitted files for images. Bilateral sagittal split osteotomy in combination with skeletal intermaxillary fixation can therefore be an alternative to distraction osteogenesis in large mandibular advancements. Surgical technique two experienced surgeons sycl, rwr performed all mandibular split procedures as previously published 12. Removal of a large odontoma by sagittal split osteotomy. In 1953, the sagittal ramus split osteotomy was introduced by obwegeser. The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. 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. Anatomic study for the horizontal cut of the sagittal split. Removal of a large odontoma by sagittal split osteotomy article in journal of oral and maxillofacial surgery 6412. Neurosensory disturbance after bilateral sagittal split osteotomy academic dissertation to be presented with the assent of the faculty of medicine, university of oulu, for public discussion in the auditorium 1 of the institute of dentistry aapistie 3, on august 23rd, 2002, at 12 noon. Jaw angle bony deformity after sagittal split mandibular.
The basic design of the sagittal ramus split surgical procedure evolved. Assessment of nerve function after mandible surgery with a. Bilateral sagittal split osteotomy dr mathieu jacquemart lyon. Abstract the bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. I was a little nervous in the preop but just wanted to get it over with. Onestage technique for sagittal split ramus osteotomy.
The lefort i,bilateral sagittal split osteotomy of the mandible, and the osseous genioplasty. 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. Dec 10, 2014 about bilateral sagittal split osteotomy surgery osteotomy is a surgery in which the bone is modified. Removal of deeply impacted mandibular molars by sagittal. 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. Straight and curved sagittal split plates are available for monocortical screw placement. Complications of bilateral sagittal split osteotomy in. Influence of the design in sagittal split ramus osteotomy on the. Pdf occurrence of bad splits during sagittal split. Le fort osteotomy transverse sectioning and repositioning of the maxilla. The sagittal split ramus osteotomy ssro is a technique with a long history and broad appli.
Right lateral and anterolateral views of jaw with sagittal split osteotomy, genioplasty, and fixation with wires and screws. The jaw is split into two sides and then screwed into the desired position. Bilateral sagittal split osteotomy bsso is commonly used to treat mandibular discrepancies 7,11,28. Hybrid fixation in the bilateral sagittal split osteotomy for. Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures. Occurrence of bad splits during sagittal split osteotomy. Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Unilateral sagittal split mandibular ramus osteotomy. Factors affecting the stability of bilateral sagittal. Bilateral sagittal split osteotomy bsso of the mandibular. Condylar positioning changes following unilateral sagittal. No differences in infections between patientspecific.
However, after this type of surgery, there are more chances of the condylar position changing, leading to higher risk of temporoman. Since its development, it has become the cornerstone of modern maxillofacial surgery and an important part of the everyday practice of many maxillofacial surgeons. 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. Stability of sagittal split ramus osteotomy used to correct class iii malocclusion. Sagittal split ramus osteotomy with mandible reduction. One of the most sensitive stages in bsso is recognition of inferior alveolar nerve entrance. 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. Eight out of the ten patients were satisfied or very satisfied with the treatment results and the other two were neither satisfied nor disappointed or slightly disappointed. The aim of this study was to evaluate a cohort of 28 patients, treated with bilateral sagittal split osteotomy bsso and psis for fixation, with regard to healing for up to 3 years. Mar, 2007 sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. The bilateral sagittal split osteotomy bsso can be considered a. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. The timing of removal of mandibular third molars m3 in sagittal split osteotomy sso has been an issue of contention. 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.
This technical note presents a noble and safe approach for medial. Sagittal split osteotomy sso is a surgical technique largely employed. Stability of bilateral sagittal split osteotomy abstract. Medivisuals sagittal split osteotomy and genioplasty. The modifications of the sagittal ramus split osteotomy. This study examined two patients exhibiting skeletal class iii malocclusion with facial asymmetry who underwent ussro for a mandibular setback.
Three lateral osteotomy designs for bilateral sagittal split. Request pdf bad splits in bilateral sagittal split osteotomy. All splits underwent operation with or without the osteotomy template by either a young doctor attending doctor or a doctor with extensive orthognathic surgery. Additional osteotomy vertical to the horizontal osteotomy. The sagittal split osteotomy obwegeserdal pont bellepker procedure 6. Original article influence of the design in sagittal split. Sagittal split osteotomy and mandibular advancement. The original operation technique by obwegeser was shortly after improved. Threedimensional evaluation of lingual split line after. Modification of the mandibular split based on a physical.
However, this modification is not devoid of complications, as. Bilateral sagittal split osteotomy bsso is a widelyperformed procedure in. The 2 most frequently used techniques are the intraoral vertical ramus osteotomy ivro and the sagittal split ramus osteotomy ssro. A panoramic image of the mandible 1 year after bilateral sagittal split osteotomy shows no defect in the mandibular inferior. Although there have been many modifications designed to improve the procedure, two of the earlier ones were suggested by hunsuck and dal pont. 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. Jan 25, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 6.
Modified bilateral sagittal split osteotomy for correction. 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. Neurosensory disturbance after bilateral sagittal split osteotomy. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Although the technique still presents a certain degree of technical difficulty, it has become a reliable procedure in orthognatic surgery. The patients medical files and orthopantomographs were screened for the. Macroglossia is defined as tongue enlargement due to muscle hypertrophy, tumor or an endocrine disturbance. The bilateral sagittal split mandibular ramus osteotomy. Jan 08, 2015 in 1953, the sagittal ramus split osteotomy was introduced by obwegeser. Pdf stability of open bite correction with sagittal. This article is from journal of the korean association of oral and maxillofacial surgeons, volume 40. 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. Modified mandibular inferior border sagittal split. After the sagittal split osteotomy, adjust the occlusion and the joint bearing segment, and stabilize by intermaxillary fixation.
It is also mandatory that the surgical correction be performed accurately to ensure predictable and successful outcomes. A 3d virtual mandible model was constructed using images from ct scan. Original article photoelastic evaluation of two different. Orthognathic surgery is also available as a very successful treatment 90100% for obstructive sleep apnea. This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry.
Pdf bad split during bilateral sagittal split osteotomy of. Neurosensory disturbance after bilateral sagittal split. Stability of bilateral sagittal split osteotomy bsso is an important goal for every surgeon. Evolution of the sagittal split ramus osteotomy of the mandible. Mandibular sagittal split osteotomy central singapore.
In rare cases the occlusal surfaces of impacted molars are united by the same follicular space and the roots pointing in opposite direction. The original operation technique by obwegeser was shortly after improved by dal ponts modification. Surgical procedures of mandibular sagittal split osteotomy on during mandibular sagittal split osteotomy, the lower jaw is removed. 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. Complications of bilateral sagittal split osteotomy in patients with mandibular prognathism. Mandibular sagittal split osteotomy orange county surgeons. The sagittal split ramus osteotomy is a wellestablished procedure, and many authors have attempted various modifications of the surgical technique. Lefort 1 osteotomy possible segmental and bilateral mandibular sagittal split osteotomy advancement what a mouthful. Reports of bsso in a mandible, reconstructed with a nonvascularised bone. 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.