Low to high oblique ramus piezoosteotomy: a pilot study.

Area of Science:

• Oral and Maxillofacial Surgery
• Orthognathic Surgery
• Surgical Innovation

Background:

• Classical bilateral sagittal split osteotomy (BSSO) presents risks including inferior alveolar nerve damage and unfavorable bone fractures ('bad splits').
• Ultrasonic bone cutting technology offers potential advantages in precision and safety for osteotomy procedures.

Purpose of the Study:

• To evaluate the clinical efficacy and safety of a novel low-to-high oblique piezoosteotomy (LHO) technique.
• To compare LHO with standard bilateral sagittal split osteotomy (BSSO) regarding surgical outcomes and complications.

Main Methods:

• Retrospective evaluation of 85 patients undergoing mandibular osteotomy.
• Comparison of three groups: LHO with standard osteosynthesis, LHO with dedicated plate osteosynthesis, and BSSO with standard osteosynthesis.
• Analysis of surgical parameters including mandibular advancement/setback, rotational changes, operation time, and complication rates (nerve damage, bad splits, hardware failure).

Main Results:

• LHO demonstrated a lower incidence of inferior alveolar nerve deficit (3% vs. 5% for BSSO) and fewer 'bad splits' (2 vs. 4 for BSSO).
• Operation time was significantly shorter with LHO, especially when using dedicated plates.
• Postoperative stability was sufficient for moderate repositioning, with reduced blood loss and possibility for gonial angle modification.

Conclusions:

• Low-to-high oblique piezoosteotomy (LHO) is a viable and potentially safer alternative to BSSO for orthognathic surgery.
• The technique offers reduced risks of nerve injury and bad splits, with improved surgical efficiency.
• Development of dedicated osteosynthesis plates addressed initial hardware complications, enhancing the overall reliability of the LHO procedure.