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Bilateral sagittal split osteotomy buccal cut classification. Indications: pros and cons.

Adaia Valls-Ontañón1, Ana Ortiz-Gutiérrez1, Francesc Duran-Vallés1

  • 1Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya (UIC), Barcelona, Spain; Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain.

The British Journal of Oral & Maxillofacial Surgery
|February 5, 2026
PubMed
Summary

This review introduces a new classification for bilateral sagittal split osteotomy (BSSO) in mandibular orthognathic surgery. The classification, based on buccal cut position, guides optimal technique selection for improved surgical outcomes.

Keywords:
Bilateral sagittal split osteotomyInferior alveolar nerveMandibular notchOrthognathic surgeryOsteotomy classification

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Orthognathic Surgery
  • Surgical Anatomy

Background:

  • Bilateral sagittal split osteotomy (BSSO) is a fundamental procedure in mandibular orthognathic surgery.
  • Existing literature lacks a comprehensive comparison of BSSO techniques, their properties, indications, and outcomes.

Purpose of the Study:

  • To propose a novel classification system for BSSO techniques.
  • To compare the technical characteristics, clinical implications, and outcomes of different BSSO approaches.
  • To provide a guide for selecting the optimal BSSO technique based on patient-specific factors.

Main Methods:

  • A narrative review of key publications on BSSO techniques was performed.
  • Authors' clinical experience was integrated with the literature review.
  • A novel classification based on the buccal cut's position relative to the mandibular notch and angle was formulated.

Main Results:

  • A classification system categorizing BSSO into pre-notch, post-notch, and post-gonial approaches was developed.
  • Pre-notch techniques are suitable for standard procedures with thick soft tissues.
  • Post-notch techniques are indicated for large movements and thin tissues, reducing notching and protecting the inferior alveolar nerve.
  • Post-gonial strategies aid in ramus lengthening and correcting vertical asymmetry.

Conclusions:

  • The proposed classification offers a simple, clinically oriented framework for BSSO.
  • This classification aligns existing BSSO modifications with specific surgical objectives.
  • It supports more precise and individualized treatment planning in mandibular orthognathic surgery.