A guiding oblique osteotomy cut to prevent bad split in sagittal split ramus osteotomy: a technical note

Abstract

Aim: To present a simple technical modification of a medial osteotomy cut which prevents its misdirection and overcomes various anatomical variations as well as technical problems.

Methods: The medial osteotomy cut is modified in the posterior half at an angle of 15°-20° following novel landmarks.

Results: The proposed cut exclusively directs the splitting forces downwards to create a favorable lingual fracture, preventing the possibility of an upwards split which would cause a coronoid or condylar fracture.

Conclusion: This modification has proven to be successful to date without encountering the complications of a bad split or nerve damage.

Keywords

Guiding oblique osteotomy cut / lingual bad splits / medial cut / sagittal split ramus osteotomy

References

[1] Wyatt WM.Sagittal ramus split osteotomy: literature review and suggested modification of technique..Br J Oral Maxillofac Surg1997;35:137-41

[2] Trauner R.Operative oral surgery: the surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty..Oral Surg Oral Med Oral Pathol1957;10:677-89

[3] Carleton AS,Peterson LJ.Prevention of the misdirected sagittal split..J Oral Maxillofac Surg1986;44:81-2

[4] Teltzrow T,Schulze A,Brachvogel P.Perioperative complications following sagittal split osteotomy of the mandible..J Craniomaxillofac Surg2005;33:307-13

[5] Cillo JE.Selection of sagittal split ramus osteotomy technique based on skeletal anatomy and planned distal segment movement: current therapy..J Oral Maxillofac Surg2005;63:109-14

[6] Mehra P,Freitas RZ.Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars..J Oral Maxillofac Surg2001;59:854-8

[7] Falter B,Vrielinck L,Thijs H.Occurrence of bad splits during sagittal split osteotomy..Oral Surg Oral Med Oral Pathol Oral Radiol Endod2010;110:430-5

[8] Doucet JC,Davis BR,Goodday R.Concomitant removal of mandibular third molars during sagittal split osteotomy minimizes neurosensory dysfunction..J Oral Maxillofac Surg2012;70:2153-63