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Vulnerable structures during intraoral sagittal split ramus osteotomy.

Kun Hwang1, Yong Seok Nam, Seung Ho Han

  • 1Department of Plastic Surgery and Center for Advanced Medical Education by BK21 Project, Inha University College of Medicine, Incheon, Korea.

The Journal of Craniofacial Surgery
|January 24, 2009
PubMed
Summary

This study mapped vulnerable anatomical structures during sagittal split ramus osteotomy (SSRO). Minimizing ramus setback can help avoid facial nerve injury, while the retromandibular vein is a likely source of bleeding.

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Area of Science:

  • Anatomy
  • Oral and Maxillofacial Surgery
  • Surgical Risk Assessment

Background:

  • Sagittal split ramus osteotomy (SSRO) is a common surgical procedure.
  • Understanding the anatomical risks associated with SSRO is crucial for patient safety.
  • Previous studies have not precisely delineated the proximity of key neurovascular structures to the osteotomy site.

Purpose of the Study:

  • To identify and map anatomical structures at risk of injury during SSRO.
  • To precisely measure the location of the facial nerve, retromandibular vein (RMV), and external carotid artery (ECA) relative to the mandible.
  • To provide anatomical data to guide surgical technique and minimize complications.

Main Methods:

  • Dissection of 29 Korean adult cadaver hemifaces.

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  • Measurement of facial nerve, RMV, and ECA positions relative to the mandibular posterior border and occlusal plane.
  • Simulation of SSRO at 10 mm intervals to assess facial nerve proximity.

    • Main Results:

    • The facial nerve trunk (FNT) was located within 9 mm of a specific point relative to the mandibular notch.
    • The FNT was 11-14 mm medial to the posterior border of the mandible (PBM).
    • The retromandibular vein (RMV) is closer to the PBM (4-9 mm) than the external carotid artery (ECA) (12-13 mm), suggesting it is a more common source of bleeding.

    Conclusions:

    • Reducing the degree of ramus setback during SSRO can help prevent facial nerve injury.
    • The RMV is more vulnerable to injury than the ECA during SSRO due to its closer proximity to the PBM.
    • Precise anatomical knowledge aids in surgical planning and risk mitigation for SSRO procedures.