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. 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. Case report removal of deeply impacted mandibular molars by. Modified mandibular sagittal split osteotomy request pdf. The basic design of the sagittal ramus split surgical procedure evolved very quickly. The procedure was initially described by hugo obwegeser in 1955 and remains an essential procedure in the plastic and maxillofacial surgeons surgical tool chest. A sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth.
Depending on the gravity of the surgery, these symptoms may remain for a long time. Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction osteogenesis. On the long side, a conventional osteotomy is performed. However, after this type of surgery, there are more chances of the condylar position changing, leading to higher risk of temporoman. 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. The basic design of the sagittal ramus split surgical procedure evolved. Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Bilateral sagittal split osteotomy bilateral sagittal split ramus osteotomy bsso is a common mandibular orthognathic procedure. It involves sagittal osteotomies of the mandible that allow repositioning of the dentate segment to address congenital or acquired dentofacial deformity. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. The bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. This allows the front part of the mandible to slide backward or forward until the teeth are aligned. Sagittal split ramal osteotomy an overview sciencedirect. Bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular prognathism or retrognathism.
Lane evidently described a similar procedure earlier, which was done extraorally. Bilateral sagittal split osteotomy jefferson university. Neurosensory disturbance after bilateral sagittal split osteotomy. This retrospective study investigated the relationship between the degree of neurosensory disturbance nsd and mandibular movement distance after sagittal split ramus osteotomy ssro and assessed sensory recovery.
The bilateral sagittal split osteotomy bsso can be considered a milestone in surgery in general. On neurosensory disturbance after sagittal split osteotomy. Bilateral sagittal split osteotomy of mandible bsso is a surgical method used to correct the sagittal, transversal and vertical position of the lower jaw. Case report removal of deeply impacted mandibular molars. B, the dal pont technique sets the cut at the horizontal ramus farther forward, which allows advancements up to 15 mm. 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. This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry. 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. Onestage technique for sagittal split ramus osteotomy. Martis, dds, md sagittal split osteotomy has been performed routinely for correction of mandibular prognathism, retrognathia, mild open bite, and asymmetry. Bilateral sagittal split osteotomy bsso is a well documented standardized and relatively safe operation to correct jaw deformities such as mandibular retrognathism. It is performed to correct types of malocclusion, a misalignment of teeth.
Lefort 1 osteotomy during this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. However, several disadvantages, such as fracture, bleeding, infection, and tmd, were found after bilateral sagittal split ramus osteotomy bssro. Complications related to mandibular advancement by. Lower lip hypoesthesia was evaluated at 1 week, 1 month, and 2 months after ssro in 38 patients categorized according to the distance of mandibular movement. 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. Condylar positioning changes following unilateral sagittal. A bilateral sagittal split osteotomy bsso is a procedure used frequently for the correction of a class ii malocclusion.
Sagittal split osteotomy sso was conceived more than 60 years ago to correct maxillofacial deformities. This article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. Meaning of sagittal split mandibular osteotomy medical term. Bilateral sagittal split osteotomy in a mandible, previously. A 728 x 942 pdf stability of unilateral sagittal split ramus 850 x 1153. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20.
Aim the gonial angle plays an important role in ensuring a harmonious facial profile. Furthermore, the study focuses on the measurement of neurosensory disturbance with easily available bedside tests, not only on evaluating the state of sensory disturbance at each followup, but also on. Stability of bilateral sagittal split osteotomy bsso is an important goal for every surgeon. 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. Faculty of dental medicine alazhar universityorthognathic surgery is the bilateral sagittal split osteotomy bsso has a wide range of. Pdf stability of open bite correction with sagittal.
Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design. The lower jaw mandible is split and moved either backward or forward to straighten it into a more balanced position. Complications of bilateral sagittal split osteotomy in patients with mandibular prognathism. Unilateral intraoral vertical ramus osteotomy and sagittal. In this paper, we share our experience on bssro with mandibular angle resection. Neurosensory disturbance is a common complication of bilateral sagittal split osteotomy bsso. Looking for online definition of sagittal split mandibular osteotomy in the medical dictionary. Pdf changes in the gonial angle following bilateral. Pdf stability of open bite correction with sagittal split. Pdf risk factors for common complications associated.
Jul 30, 2019 intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy. Orthognathic surgery is also available as a very successful treatment 90100% for obstructive sleep apnea. Acute traumatic injury, and postsurgical sequela see postsurgical sequela in. Factors affecting the stability of bilateral sagittal split. Le fort osteotomy transverse sectioning and repositioning of the maxilla.
Sagittal split osteotomy may lead to facial swelling, discomfort in the throat or teeth. Bertossi, university hospital, verona it sagittal split osteotomy performed with mt110 surgical insert dr. 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. Mandibular sagittal split ramus osteotomy is the most common mandibular orthognathic procedure. Jan 22, 2018 sagittal split osteotomy a surgical procedure resembling the saggital split osteotomy was described in 1942 in the german literature by schuchardt. Bilateral sagittal split osteotomy with asymmetric 516 x 963. It is also mandatory that the surgical correction be performed accurately to ensure predictable and successful outcomes. Apr 23, 2015 another modification of sagittal split ramus osteotomy ssro is described as follows.
The purpose of this retrospective study was to assess the incidence of the neurosensory disturbance nsd after sagittal split osteotomy and evaluate nsd in relation to patient age, gender. This osteotomy technique originally was described by trauner and obwegeser in 1957. Bilateral sagittal split osteotomy bsso aims to correct congenital or acquired mandibular abnormities. Another modification of sagittal split ramus osteotomy ssro is described as follows. 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. Bilateral sagittal spilt osteotomy and genioplasty in. 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. Threedimensional analysis of longterm stability after. 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. On the short side, unlike a usual lingual osteotomy made horizontally above the lingual osteotomy, the osteotomy was angled downward and the buccal osteotomy was made horizontally below the lingual. Factors affecting the stability of bilateral sagittal. Complications after mandibular sagittal split osteotomy.
This chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus. This study focuses on the evaluation of factors affecting neurosensory disturbance after bsso. 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 bsso is performed on the lower jaw, the mandible, in order to move it forward in the case of a deficient lower jaw. A, obwegesers technique of intraoral sagittal split ostoetomy. In the article factors influencing stability of the surgery result. On the short side, unlike a usual lingual osteotomy made horizontally above the lingual osteotomy, the osteotomy was angled downward and the buccal osteotomy was made horizontally below the lingual osteotomy. This article shows that sagittal split osteotomy of the mandible can be very useful to access various pathologies in the body, angle, and ramus of the mandible and to navigate lesions that are in proximity to the inferior. Patients with mandibular prognathism or retrognathism may also present with a prominent mandibular angle. The bilateral sagittal split mandibular ramus osteotomy. Jan 08, 2015 in 1953, the sagittal ramus split osteotomy was introduced by obwegeser.
Introduction along with great increase in our knowledge over maxillofacial abnormalities and their surgical treatment during the recent decades, mandibular osteotomy. Surgical access to a complex composite odontoma via sagittal. Mar 16, 2020 a sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. Bilateral sagittal split ramus osteotomy introduced by trauner and obwegeser has usually been used to correct facial asymmetry. Orthognathic surgery is a well established and widely used treatment option for insufficient growth of the maxilla in patients with an orofacial cleft. The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks.
Occurrence of bad splits during sagittal split osteotomy. Temporary or permanent neurosensory disturbance is the most frequent complication of bsso. Dec 16, 2016 the bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. A guiding oblique osteotomy cut to prevent bad split in. Sagittal split osteotomy and mandibular advancement. A guiding oblique osteotomy cut to prevent bad split in sagittal split ramus osteotomy. In 1953, the sagittal ramus split osteotomy was introduced by obwegeser. Complications of bilateral sagittal split osteotomy in. Aug 31, 2016 bilateral sagittal spilt osteotomy and genioplasty in patient with lymphatic malformation video type. Mar, 2007 sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. The following are eligible for coverage as reconstructive and medically necessary. The incidence of nsd after sagittal split osteotomy increases in patients over the age of 40. The cut at the outer cortex ends at the gonial angle, which allows rotation, but not large advancements. The aim of the present study was to evaluate gonial angle changes after mandibular setback by the bilateral sagittal split osteotomy bsso and vertical ramus osteotomy vro techniques.
The influence of bilateral sagittal split ramus osteotomy. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. 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. Alpergultekin 1,2 department of oral and maxillofacial surgery, istanbul university, faculty of dentistry, istanbul, turkey. Neurosensory disturbance after bilateral sagittal split. The most common complications that are associated with bilateral sagittal split osteotomy are. Patients have to go on a fluid diet, which means they cannot have anything other than fluid or extremely soft foods. The bone on the sagittal or side of the lower mandible of the jaw is cut on each side to form a split. 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.
Reports of bsso in a mandible, reconstructed with a nonvascularised bone. Sagittal split osteotomy, orthognathic jaw surgery for. Although the technique still presents a certain degree of technical difficulty, it has become a reliable procedure in orthognatic surgery. Mandibular osteotomies in orthognathic surgery of face. Bilateral sagittal split osteotomy and genioplasty in 5yo girl with lymphatic malformation bilateral sagittal split osteotomy and genioplasty in 5yo girl with lymphatic malformation escort eskisehir escort izmit k. Bilateral sagittal spilt osteotomy and genioplasty in patient. Jan 23, 2017 it is also mandatory that the surgical correction be performed accurately to ensure predictable and successful outcomes. Hypoesthesia associated with mandibular movement after. Bilateral sagittal split osteotomy bsso is a widely used orthognathic surgical technique. Since its development, it has become the cornerstone of modern maxillofacial surgery and an important part of the everyday practice of many maxillofacial surgeons. Jan 29, 2018 bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular prognathism or retrognathism. Four patients 9% were not satisfied, but only 1 attributed the dissatisfaction to sensory impairment. For many years, and in some countries still, this technique has defined the term oral and maxillofacial surgery.
The sagittal split osteotomy is one of the most commonly used procedures to correct a mandible retrusion overbite, or a mandibular prognathism underbite. What does sagittal split mandibular osteotomy mean. Sagittal split osteotomy definition of sagittal split. 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 j korean assoc oral maxillofac surg 2014. Patients with mandibular prognathism or retrognathism may also present with a. Sagittal split osteotomy a surgical procedure resembling the saggital split osteotomy was described in 1942 in the german literature by schuchardt. Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures. Lefort 1 osteotomy possible segmental and bilateral mandibular sagittal split osteotomy advancement what a mouthful. 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 modifications of the sagittal ramus split osteotomy. This case report presents the removal of complex composite odontoma in a young patient in the right body of mandible via the unilateral sagittal splitting of the mandible. Threedimensional analysis of longterm stability after bilateral sagittal split ramus osteotomy fixed with a single miniplate with 4 monocortical screws and 1 bicortical screw. Case report removal of deeply impacted mandibular molars by sagittal split osteotomy erolcansiz, 1 sabricemilisler, 1 andb. Pdf occurrence of bad splits during sagittal split.
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