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Updated: Jan 18, 2026
Author Spotlight: Development of a Novel Finite Element Analysis Model for Improved Orthognathic Surgical Techniques
Published on: October 20, 2023
Impact of osteotomy angle on bone failure risk in a modified pull-through approach: a finite element analysis
Vincenzo Orassi1,2, Philipp Ruf1,3, Elena Hofmann3,4
1Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
Background:
A modified pull-through approach represents a promising treatment strategy to access tumors in the posterior oral cavity. The design of the wedge osteotomy plays a key role in preserving postoperative mechanical stability while enabling surgical access. However, the optimal osteotomy design to reduce fracture risk remains unclear. Therefore, this study aimed to test osteotomy wedge designs that have the potential to lower the bone fracture risk.
Methods:
Four wedge osteotomy configurations were compared using finite element analysis based on a realistic mandible model. Each design differed in the angles and curvature of the osteotomy planes. Unilateral molar clenching was simulated, and mechanical strains were quantified and compared to the yield strain of cortical bone in the canine region to evaluate the risk of bone failure.
Results:
The finite element analysis showed that a wedge osteotomy with less acute angles in the canine region has a lower fracture risk when compared to osteotomies with sharp angles. Peak bone strain values could be reduced by half by changing the osteotomy angle at the canine region.
Conclusions:
A larger angle between the osteotomy cutting planes offers mechanical advantages by reducing strain concentrations in critical regions. These findings provide valuable guidance for refining the current surgical technique and support the integration of biomechanical analyses into osteotomy planning to optimize surgical outcomes.
Insights
Optimizing wedge osteotomy design for posterior oral cavity tumor access can reduce mandibular fracture risk. Larger angles in the canine region significantly decrease bone strain, enhancing surgical stability and outcomes.
Area of Science:
- Oral surgery
- Biomechanical engineering
- Maxillofacial reconstruction
Background:
- Modified pull-through approaches are vital for posterior oral cavity tumor access.
- Wedge osteotomy design is critical for maintaining mandibular stability post-surgery.
- Optimal osteotomy designs to minimize fracture risk require further investigation.
Purpose of the Study:
- To evaluate different wedge osteotomy designs for their potential to reduce mandibular fracture risk.
- To identify osteotomy configurations that enhance mechanical stability in the posterior oral cavity.
Main Methods:
- Finite element analysis was used to compare four distinct wedge osteotomy configurations.
- A realistic mandible model was employed, simulating unilateral molar clenching.
- Mechanical strains were quantified and compared against the yield strain of canine region cortical bone.
Main Results:
- Osteotomies with less acute angles in the canine region demonstrated a lower fracture risk.
- Peak bone strain was reduced by up to 50% through adjustments in the canine region osteotomy angle.
- Sharper angles in osteotomy designs correlated with increased fracture risk.
Conclusions:
- A larger angle between osteotomy planes mechanically benefits the mandible by reducing strain concentrations.
- Findings support refining surgical techniques for posterior oral cavity access.
- Integrating biomechanical analysis into osteotomy planning can optimize surgical results.
