Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus...

Area of Science:

• Oral and Maxillofacial Surgery
• Orthognathic Surgery
• Surgical Anatomy

Background:

• Bilateral sagittal split ramus osteotomy (BSSO) is a common procedure for correcting mandibular deformities.
• Fracture patterns during BSSO can lead to complications.
• Controlling the lingual cortical fracture pattern is crucial for surgical outcomes.

Purpose of the Study:

• To evaluate the impact of an additional inferior border osteotomy on the lingual cortical fracture pattern during BSSO.
• To determine if this modification influences the direction and type of lingual bone splitting.

Main Methods:

• A comparative study involving 20 patients with mandibular deformities undergoing BSSO.
• One side of the mandible received a traditional BSSO, while the contralateral side had an additional 1 cm horizontal osteotomy at the inferior border.
• Three-dimensional cone-beam computed tomography (3D CBCT) was used to analyze and classify lingual split patterns.

Main Results:

• The inferior border osteotomy group showed a trend towards lingual splits directed towards the inferior and posterior borders of the mandible.
• Specifically, the inferior border osteotomy group had a lower incidence of unfavorable fractures (0% vs 7.5%) compared to the traditional BSSO group.
• A statistically significant difference (p < 0.05) was observed in the distribution of lingual split patterns between the two surgical techniques.

Conclusions:

• An inferior border osteotomy in BSSO appears to favorably alter the lingual cortical fracture pattern.
• This modification may help minimize unfavorable fractures and direct the split towards the lower and posterior mandible.
• Further research is warranted to validate these preliminary findings.