Evaluation of a Custom Three-Dimensional Surgical Guide in Mandibular Sagittal Split Osteotomy: An Exploratory...

Area of Science:

• Oral and Maxillofacial Surgery
• Orthognathic Surgery
• Surgical Navigation

Background:

• Sagittal split osteotomy (SSO) is a common procedure in orthognathic surgery.
• Conventional freehand SSO can be associated with unpredictable outcomes and potential complications.
• Custom three-dimensional (3D) surgical guides offer potential for improved precision in osteotomies.

Purpose of the Study:

• To evaluate the efficacy of a custom 3D surgical guide in improving mandibular sagittal split osteotomy outcomes.
• To compare the precision of guided SSO with conventional freehand SSO.
• To assess the impact of 3D surgical guides on specific osteotomy parameters and nerve exposure.

Main Methods:

• An exploratory split-mouth randomized controlled trial was conducted.
• Patients underwent SSO with a custom 3D surgical guide on one side and freehand on the contralateral side.
• Primary outcome: postoperative lingual split scale (LSS). Secondary outcomes: lateral osteotomy end (LOE) and inferior alveolar nerve exposure (NE).

Main Results:

• Fifteen patients (30 sides) were analyzed.
• Guided SSO sides demonstrated significantly more favorable LSS (p=0.041) and LOE (p=0.041) compared to freehand sides.
• No significant difference in intraoperative inferior alveolar nerve exposure (NE) was found (p=0.763).

Conclusions:

• Custom 3D surgical guides are associated with improved lingual split patterns and lateral osteotomy end accuracy in SSO.
• Findings are primarily relevant to skeletal Class III patients.
• The use of 3D guides did not significantly reduce intraoperative nerve exposure in this study.