Do Computed Tomography Findings Affect Operating Time in Bi-Lateral Sagittal Split Osteotomy? A Pilot Study

Background/Objectives: The aim of this study was to investigate the association between patient demographics and overall operating time during bilateral sagittal split osteotomy (BSSO). Methods: For this retrospective study, data were collected from patients who had undergone BSSO in our hospital between 2016 and 2023. The mandibular body and mandibular ramus were evaluated from preoperative computed tomography (CT), and CT attenuation values of cortical and cancellous bone in the mandibular ramus were obtained from standardized preoperative CT images. Patient demographics (age, sex, occlusal class, and body weight) before surgery were also collected from the medical record. Results: Forty-six patients were included in this study. Weight and CT attenuation of the mandibular ramus (both cortical and cancellous bone) correlated with operating time (weight: rs = 0.304, p = 0.04; CT attenuation of mandibular ramus: rs = 0.323, p = 0.029). In addition, the Mann-Whitney U test revealed significantly greater operating time in males (p < 0.05). Effects of each variable were estimated after adjusting for other variables, and CT attenuation of the mandibular ramus (both cortical and cancellous bone) (B = 0.088, p = 0.008) was identified as having an effect on operating time. Higher CT attenuation, reflecting greater cortical and cancellous bone density, may increase resistance during osteotomy and consequently prolong operating time. Conclusions: This pilot study observed a possible association between CT attenuation of the mandibular ramus and operating time in BSSO. However, these findings are preliminary and do not imply any causal relationships. Thus, further studies with larger cohorts are required to confirm these observations.