Mandibular Anatomical Risk Factors for Bad Split During Sagittal Split Ramus Osteotomy
Article Sidebar
Main Article Content
Abstract
Objective: This study aimed to assess the correlation between mandibular anatomy and the occurrence of bad splits in Sagittal split osteotomy (SSO).
Materials and Methods: Pre-surgical CBCT images of 10 patients with bad split (bad split group) and 40 patients without bad split (normal group) were evaluated. Anatomical parameters of the mandible related to the osteotomy line were measured. Conditional logistic regression and receiver operating characteristic (ROC) curve analyses were performed.
Results: Results showed that a shorter height from the lingula to the fusion of buccal and lingual cortices (HLBC; p=0.009) and thicker distance between outer surfaces of buccal and lingual cortical plates of ramus at the level of the lingula (BTRL; p=0.028) were significantly associated with the occurrence of a bad split. ROC analysis revealed an HLBC cut-off of 7.5 mm.
Conclusion: This study suggests that patients with a shorter height from the lingula to the fusion of buccal and lingual cortices less than 7.5 mm are at higher risk of bad splits during SSO. Surgeons should exercise caution in such cases to minimize complications.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการลงตีพิมพ์ในวิทยาสารทันตแพทยศาสตร์ มหาวิทยาลัยขอนแก่นถือเป็นลิขสิทธิ์เฉพาะของคณะทันตแพทยศาสตร์ มหาวิทยาลัยขอนแก่น หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใด ๆ จะต้องได้รับอนุญาตเป็นลายลักษณ์อักษร จากคณะทันตแพทยศาสตร์ มหาวิทยาลัยขอนแก่นก่อนเท่านั้น
References
Ruiz LP, Lara JC. Facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible. Int J Oral Maxillofac Surg. 2011;40(8):884-6.
Ow A, Cheung LK. Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction osteogenesis: an evidence-based review. J Oral Maxillofac Surg. 2009;67(11):2344-53.
Rai KK, Shivakumar HR, Sonar MD. Transient facial nerve palsy following bilateral sagittal split ramus osteotomy for setback of the mandible: a review of incidence and management. J Oral Maxillofac Surg. 2008;66(2):373-8.
Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol. 1957;10(7):677-89;contd.
Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol. 1957;10(8):787-92; contd.
Dal Pont G. Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv. 1961;19:42-7.
Hunsuck EE. A modified intraoral sagittal splitting technic for correction of mandibular prognathism. J Oral Surg. 1968;26(4):250-3.
Bloomquist DS, Lee JJ. Mandibular orthognathic surgery. In: Miloro M, Ghali GE, Larsen PE, Waite PD, editors. Peterson’s principles of oral and maxillofacial surgery. 3rd ed. Shelton, CT: PMPH-USA; 2011. p. 1317-64.
Sousa CS, Turrini RNT. Complications in orthognathic surgery: a comprehensive review. J Oral Maxillofac Surg Med Pathol. 2012;24(2):67-74.
Mehra P, Castro V, Freitas RZ, Wolford LM. Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars. J Oral Maxillofac Surg. 2001;59(8):854-8.
O’Ryan F. Complications of orthognathic surgery. Oral Maxillofac Surg Clin North Am. 1990;2:593-613.
Veras RB, Kriwalsky MS, Hoffmann S, Maurer P, Schubert J. Functional and radiographic long-term results after bad split in orthognathic surgery. Int J Oral Maxillofac Surg. 2008; 37(7):606-11.
Kriwalsky MS, Maurer P, Veras RB, Eckert AW, Schubert J. Risk factors for a bad split during sagittal split osteotomy. Br J Oral Maxillofac Surg. 2008;46(3):177-9.
Teltzrow T, Kramer FJ, Schulze A, Baethge C, Brachvogel P. Perioperative complications following sagittal split osteotomy of the mandible. J Craniomaxillofac Surg. 2005;33(5):307-13.
Jędrzejewski M, Smektała T, Sporniak-Tutak K, Olszewski R. Preoperative, intraoperative, and postoperative complications in orthognathic surgery: a systematic review. Clin Oral Investig. 2015;19(5):969-77.
Simpson W. Problems encountered in the sagittal split operation. Int J Oral Surg. 1981;10(2):81-6.
Falter B, Schepers S, Vrielinck L, Lambrichts I, Thijs H, Politis C. Occurrence of bad splits during sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(4):430-5.
Posnick JC, Choi E, Liu S. Occurrence of a 'bad' split and success of initial mandibular healing: a review of 524 sagittal ramus osteotomies in 262 patients. Int J Oral Maxillofac Surg. 2016; 45(10):1187-94.
Reyneke JP, Tsakiris P, Becker P. Age as a factor in the complication rate after removal of unerupted/impacted third molars at the time of mandibular sagittal split osteotomy. J Oral Maxillofac Surg. 2002;60(6):654-9.
Friscia M, Sbordone C, Petrocelli M, Vaira LA, Attanasi F, Cassandro FM, et al. Complications after orthognathic surgery: our experience on 423 cases. Oral Maxillofac Surg. 2017;21(2):171-7.
Aarabi M, Tabrizi R, Hekmat M, Shahidi S, Puzesh A. Relationship between mandibular anatomy and the occurrence of a bad split upon sagittal split osteotomy. J Oral Maxillofac Surg. 2014; 72(12):2508-13.
Wang T, Han JJ, Oh HK, Park HJ, Jung S, Park YJ, Kook MS. Evaluation of mandibular anatomy associated with bad splits in sagittal split ramus osteotomy of mandible. J Craniofac Surg. 2016;27(5):e500-4.
Guernsey LH, DeChamplain RW. Sequelae and complications of the intraoral sagittal osteotomy in the mandibular rami. Oral Surg Oral Med Oral Pathol. 1971;32(2):176-92.
Tom WK, Martone CH, Mintz SM. A study of mandibular ramus anatomy and its significance to sagittal split osteotomy. Int J Oral Maxillofac Surg. 1997;26(3):176-8.
Wolford LM, Bennett MA, Rafferty CG. Modification of the mandibular ramus sagittal split osteotomy. Oral Surg Oral Med Oral Pathol. 1987;64(2):146-55.
Scomparin L, Soares MQ, Rubira CM, Yaedu RY, Imada TS, Centurion BS, et al. CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: importance to sagittal split osteotomy. Med Oral Patol Oral Cir Bucal. 2017;22(4):e500-e5.
Sant'Ana E, Souza DPE, Temprano AB, Shinohara EH, Faria PEP. Lingual Short Split: A Bilateral Sagittal Split Osteotomy Technique Modification. J Craniofac Surg. 2017;28(7):1852-4.
Telha W, Abotaleb B, Zhang J, Bi R, Zhu S, Jiang N. Correlation between mandibular anatomy and bad split occurrence during bilateral sagittal split osteotomy: a three-dimensional study. Clin Oral Investig. 2023;27(3):1035-42.
Jiang N, Wang M, Bi R, Wu G, Zhu S, Liu Y. Risk factors for bad splits during sagittal split ramus osteotomy: a retrospective study of 964 cases. Br J Oral Maxillofac Surg. 2021;59(6):678-82.
Mensink G, Verweij JP, Frank MD, Eelco Bergsma J, Richard van Merkesteyn JP. Bad split during bilateral sagittal split osteotomy of the mandible with separators: a retrospective study of 427 patients. Br J Oral Maxillofac Surg. 2013;51(6):525-9.
Fujii Y, Hatori A, Horiuchi M, Sugiyama-Tamura T, Hamada H, Sugisaki R, et al. Computed tomography evaluation of risk factors for an undesirable buccal split during sagittal split ramus osteotomy. PLoS One. 2023;18(3):e0279850.
Noleto JW, Marchiori E, Da Silveira HM. Evaluation of mandibular ramus morphology using computed tomography in patients with mandibular prognathism and retrognathia: elevance to the sagittal split ramus osteotomy. J Oral Maxillofac Surg. 2010;68(8):1788-94.
