Place of sagittal split osteotomy in mandibular surgery

Unilateral sagittal split osteotomy: effect on mandibular symmetry in the treatment of class III with laterognathia

The bilateral sagittal split osteotomy is considered the standard surgery to correct facial asymmetries. More recently, unilateral sagittal split osteotomy (USSO) was used to treat such malocclusions.

AIM

To assess facial symmetry following USSO in the treatment of class III laterognathia.

METHODS

Frontal facial photographs of four groups of patients were assessed: (1) pre-surgical group (n = 30) with skeletal asymmetry, (2) postsurgical group assessing patients of the first group 2 years after USSO, (3) control group (n = 30) of patients judged to have harmonious facial norms, and (4) mirrored group (n = 30) in which the control photographs were altered by duplicating the right half side of the face to replace the left half, thus creating perfectly symmetrical faces. All 120 photographs were distributed to 40 expert orthodontists to evaluate and score facial symmetry using the visual analog scale. Skin sensitivity and temporomandibular joint (TMJ) disorders were also assessed clinically pre and postsurgically.

RESULTS

Statistically significant differences were observed between the pre-surgical group and each of the postsurgical and control groups (p < 0.001). The control and postsurgical groups received similar scores of symmetry (p = 0.774). The mirrored group received statistically significantly higher symmetry scores than either of the control or the postsurgical groups (p < 0.001). A reduction in TMJ disorders was noted after USSO and all patients reported normal skin sensation 2 years post-surgery.

CONCLUSION

When indicated, USSO is a dependable and practical surgical approach to correct facial asymmetries associated with class III malocclusion.

Stability of unilateral sagittal split ramus osteotomy for correction of facial asymmetry: long-term case series and literature review

Bilateral sagittal split ramus osteotomy is considered a standard technique in mandibular orthognathic surgeries to reduce unexpected bilateral stress in the temporomandibular joints. Unilateral sagittal split ramus osteotomy (USSO) was recently introduced to correct facial asymmetry caused by asymmetric mandibular prognathism and has shown favorable outcomes. If unilateral surgery could guarantee long-term postoperative stability as well as favorable results, operation time and the incidence of postoperative complications could be reduced compared to those in bilateral surgery. This report highlights three consecutive cases with long-term follow-up in which USSO was used to correct asymmetric mandibular prognathism. Long-term postoperative changes in the condylar contour and ramus and condylar head length were analyzed using routine radiography and computed tomography. In addition, prior USSO studies were reviewed to outline clear criteria for applying this technique. In conclusion, patients showing functional-type asymmetry with predicted unilateral mandibular movement of less than 7 mm can be considered suitable candidates for USSO-based correction of asymmetric mandibular prognathism with or without maxillary arch surgeries.

Condylar resorption and functional outcome after unilateral sagittal split osteotomy

OBJECTIVE

The objective of this study was to evaluate the radiological and functional results of unilateral sagittal split osteotomy (USSO) of the mandible.

STUDY DESIGN

Between January 2001 and December 2008, 26 patients underwent USSO to correct laterognathia (isolated USSO in 3 patients and Le Fort I osteotomies in combination with USSO in 23 patients). Radiographs of 23 patients were evaluated for signs of condylar resorption or loss of ramus height; 16 patients were clinically examined and the movement of both condyles was measured with a nontouch device.

RESULTS

Unilateral condylar resorption was observed in 1 patient and bilateral signs of resorption with loss of ramus height were observed in a further patient. Mouth opening and protrusion were significantly reduced after surgery (6.06 ± 6.91 mm, P = .005/0.63 ± 0.89 mm, P = .020). The selected surgical site, whether left or right, had no influence on laterotrusion or retrusion (P > .05), but patients operated on the right side showed higher values of protrusion on the left side than patients who were operated on the left (mean difference: 3.13 ± 1.24 mm; P = .038).

CONCLUSIONS

USSO appears to be a procedure that can be used in orthognathic surgery, if applied to a certain extent. In this study, there was no evidence of adverse results in terms of condylar resorption or functional outcome when compared with the results of regular bilateral sagittal split osteotomy (BSSO) reported in the literature. To our best knowledge this is the first study in the literature investigating the impact of USSO in orthognathic surgery.

Osteomyelitis after bilateral sagittal split osteotomy: case report and a review of the management

OBJECTIVES

The purpose of this paper is to report a case of osteomyelitis following a bilateral sagittal split osteotomy in a patient who underwent 2-jaw surgery. A review of the management of osteomyelitis is included, with a discussion of implications for the reconstruction of the mandible after treatment for osteomyelitis.

STUDY DESIGN

A case of a rapidly progressing osteomyelitis is presented with a detailed review of the management of osteomyelitis, using this case to illustrate key points of management.

RESULTS

In a very short period of time the patient lost a significant portion of the left side of her mandible. The actual management that she underwent, as well as some of the controversies that are present with the treatment of osteomyelitis, is discussed.

CONCLUSION

Although osteomyelitis of the mandible usually is seen after odontogenic infections and trauma, it can occur in patients undergoing elective osteotomies. When recognized, it should be aggressively treated.