Factors influencing the stability of the sagittal split osteotomy for mandibular advancement

Relapse continues to be a potential problem with use of the sagittal split osteotomy to advance the mandible. In an effort to isolate predictive factors, the records of 235 patients were analyzed to determine the pretreatment facial morphology, the amount of advancement, the amount of relapse, and the duration of relapse. No relationship was found between any of the measures of facial morphology and relapse. However, the amount of advancement, the amount of relapse, and the duration of relapse all were found to be strongly related. It was found that all patients shared a similar facial morphology, and thus no influence of facial form on relapse would be expected from this group. The relationships between advancement and relapse could be attributed to neuromuscular adaptation, which would be more prolonged and more extensive in instances of greater advancement, and thus give rise to relapse of greater extent and duration. It is therefore suggested that mandibular advancements of greater than 10 mm be fixed more rigidly and for a greater length of time than those of lesser magnitude.