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Correlation between mandibular anatomy and bad split occurrence during bilateral sagittal split osteotomy: a

Wael Telha¹, Bassam Abotaleb¹, Jie Zhang¹

¹State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases and Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3 of Renmin Nan Road, Chengdu, 610041, Sichuan, China.

Clinical Oral Investigations

|August 11, 2022

Summary

Mandible anatomy influences bad splits during bilateral split sagittal ramus osteotomy (BSSRO). Narrow buccal cortical bone and reduced cancellous bone thickness are linked to this complication.

Keywords:

Anatomical landmarks Bad split fracture Intraoperative complication Orthognathic surgery Sagittal split osteotomy

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Area of Science:

Oral and Maxillofacial Surgery
Anatomical Studies
Surgical Complications

Background:

Bilateral split sagittal ramus osteotomy (BSSRO) is a common procedure in orthognathic surgery.
Intraoperative complications, such as the 'bad split,' can occur during BSSRO.

Purpose of the Study:

To investigate the correlation between specific mandibular anatomical parameters and the incidence of bad splits in BSSRO patients.
To identify anatomical risk factors associated with BSSRO-related bad splits.

Main Methods:

Measurements of various mandibular parameters were taken, including distances from the inferior dental canal (IDC) to cortical bone, bone thickness (buccal cortical, cancellous, and total), and ramus dimensions.
Statistical analyses, including paired and independent t-tests, were employed to compare anatomical parameters between sides with and without bad splits.

Main Results:

A significant difference was observed in the distance from the inferior dental canal (IDC) to the buccal cortical margin (MCBC1) between bad and non-bad split sides (P=0.037).
Reduced thickness of buccal cancellous bone (WBCA1, WBCA2) and total cancellous bone (WCA1, WCA2) were significantly associated with bad splits (P<0.05).

Conclusions:

A narrow space between the inferior dental canal (IDC) and the buccal cortical margin is implicated in bad split occurrence.
Decreased thickness of buccal and total cancellous bone along the osteotomy path is a significant risk factor for intraoperative bad splits during BSSRO.