[Mandibular advancement: bilateral sagittal split versus -distraction osteogenesis]

Area of Science:

• Oral and Maxillofacial Surgery
• Orthognathic Surgery
• Surgical Innovation

Context:

• The introduction of intra-oral distraction osteogenesis (DO) in the 1990s offered a potential alternative to traditional bilateral sagittal split osteotomy (BSSO) for mandibular advancement.
• Initial assumptions suggested DO provided superior stability and reduced neurosensory disturbances compared to BSSO.
• A lack of robust scientific evidence supported these initial claims.

Purpose:

• To compare the efficacy, stability, and patient outcomes of distraction osteogenesis (DO) versus bilateral sagittal split osteotomy (BSSO) for mandibular advancement.
• To evaluate neurosensory disturbances of the inferior alveolar nerve associated with both procedures.
• To assess patient-reported pain and overall treatment costs.

Summary:

• Recent prospective studies indicate that BSSO is not inferior to DO regarding treatment stability and inferior alveolar nerve neurosensory disturbances.
• BSSO procedures result in significantly less patient pain and lower overall treatment costs compared to DO.
• Mandibular advancement up to 10 mm in non-syndromal patients demonstrates BSSO as a viable and potentially superior standard therapy.

Impact:

• Challenges the long-held assumptions about the superiority of distraction osteogenesis for mandibular advancement.
• Provides evidence-based recommendations for surgical planning in orthognathic surgery.
• Highlights the cost-effectiveness and patient comfort benefits of bilateral sagittal split osteotomy, influencing clinical practice guidelines.