All of these disadvantages were solved by the sagittal split osteotomy revolutionary for the time, and which was first tested in an edentulous patient under sedation and local anesthesia in february 1953 fig. The benefits include correction of the skeletal class, affording better masticatory function, reduced temporomandibular joint pain, improved facial aesthetics, and alleviation of obstructive sleep apnea. Bilateral sagittal split osteotomy bsso is the main surgical tool for correcting skeletal discrepancies in the lower face patel and novia 2007. Computed tomographic analysis of the position and course of the mandibular canal. The technique has undergone numerous modifications. The bone on the sagittal or side of the lower mandible of the jaw is cut on each side to form a split. Although the technique still presents a certain degree of technical difficulty, it has become a reliable procedure in orthognatic surgery. The bilateral sagittal split osteotomy is an indispensable surgical procedure for the. Hypoesthesia of the inferior alveolar nerve ian is a common. The surgical technique of the sagittal split mandibular ramus osteotomy can be performed in 32 steps. Patients with mandibular prognathism or retrognathism may also present with a. Here we will see about the basic technique of bsso explained in a simple way along with its advantages, disadvantages, and complications. The technique has been in practice since the late 1800s, but did not reach widespread acceptance and use until several modifications were described in the 1960s and 1970s. Bilateral sagittal split osteotomy bsso is widely used to correct jaw deformities.
While there is little doubt about the usefulness of bsso in the conventional mandibular setback, its role in asymmetric mandibular setback ams is still a matter of controversy. To evaluate piezosurgery for bilateral sagittal split osteotomy bsso for its duration and inferior alveolar nerve ian perturbation. Apr 25, 2020 a sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. It is performed to correct types of malocclusion, a misalignment of teeth. Bilateral sagittal split ramus osteotomy an orthognathic surgery done at richardson dental and craniofacial hospital, nagercoil, tamilnadu, india. The influence of bilateral sagittal split ramus osteotomy on. Translation find a translation for bilateral saggital split osteotomy jaw surgery in other languages. Nov 11, 2019 in bilateral sagittal split osteotomy bsso, the risk of lesion of the inferior alveolar nerve ian is important. Bilateral sagittal split osteotomy in a mandible, previously.
The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks. Changes in the gonial angle following bilateral sagittal. Sagittal split ramal osteotomy an overview sciencedirect. Pdf the technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with. Materials and methods the authors undertook a retrospective multicenter cohort study comparing 3 bsso techniques for advancements greater than 5 mm. Since then, several modifications of the technique have been introduced with the aim of improving surgical convenience, minimizing morbidity, and maximizing procedural stability. Influence of osteotomy design on bilateral sagittal split. Bilateral sagital split osteotomy, lip paresthesia, mandibular advancement, neurosensory disturbance, two point discrimination test.
Bilateral sagittal split osteotomy bsso in orthognathic surgery is one of the most used techniques. Mar, 2007 sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Changes in this angle after surgery may be an esthetic concern for both the patient and the surgeon. Aim the gonial angle plays an important role in ensuring a harmonious facial profile. Sagittal split osteotomy sso was described by obwegeser et al in 19551 for the correction of both prognathism and mandibular deficiency. Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design. Neurosensory deficits after bilateral sagittal split osteotomy of the mandibleinfluence of sort tissue handling medial to the ascending ramus. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Onestage technique for sagittal split ramus osteotomy. Bilateral sagittal split osteotomy pubmed central pmc. His parents brought him to our hospital for surgical correction of his prognathism. Jan 08, 2015 the bilateral sagittal split osteotomy bsso can be considered a milestone in surgery in general. Neurosensory disturbance following bilateral sagittal split.
The aim of the present study was to evaluate gonial angle changes after mandibular setback by the bilateral sagittal split osteotomy bsso and vertical ramus osteotomy vro techniques. Distraction osteogenesis versus bilateral sagittal split osteotomy for. Reports of bsso in a mandible, reconstructed with a nonvascularised bone. This allows the front part of the mandible to slide backward or forward until the teeth are aligned.
However, several disadvantages, such as fracture, bleeding, infection, and tmd, were found after bilateral sagittal split ramus osteotomy bssro. The bilateral sagittal split osteotomy bsso can be considered a milestone in surgery in general. The current most common technique for repositioning of the mandible, bilateral sagittal split osteotomy bsso, was first described by obwegeser and dal pont in the early1960s, and has since been. This osteotomy technique originally was described by trauner and obwegeser in 1957. Bsso bilateral saggital split osteotomy jaw surgery. Mar 26, 2010 bilateral sagittal split osteotomy bsso is the most common orthognathic surgical procedure. A bsso is performed on the lower jaw, the mandible, in order to move it forward in the case of a deficient lower jaw, or backward in the case of a large. Lane evidently described a similar procedure earlier, which was done extraorally. This study focuses on the evaluation of factors affecting neurosensory disturbance after bsso. May 06, 2014 bilateral sagittal split ramus osteotomy an orthognathic surgery done at richardson dental and craniofacial hospital, nagercoil, tamilnadu, india. A bilateral sagittal split osteotomy technique modification article pdf available in journal of craniofacial surgery 287.
Bsso is often performed in young, otherwise healthy individuals as for orthognatic surgery in general, and there should therefore be a low occurrence of complications and adverse events. Use of bone grafts or modified bilateral sagittal split. Originally developed in the middle of the last century by hugo obwegeser, at the department of surgery, medical university of graz, austria, the technique quickly found its way into the armamentarium of surgical procedures in orthognathic surgery. Neurosensory disturbance after bilateral sagittal split osteotomy. This study investigated a new technique for the bilateral sagittal split osteotomy bsso by adding a new osteotomy line at the inferior border of the mandible in the obwegeserdal pont operation. The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities.
The most recent modification maximizes bony interface by splitting the mandible at the inferior. Bilateral sagittal split osteotomy bsso is an effective and commonly used treatment to correct mandibular hypo and hyperplasia. It was first described by trauner and obwegeser in 1957. Surgical correction of asymmetric mandibular prognathism with.
Bilateral sagittal split osteotomy bsso is a widely used orthognathic surgical technique. Jan 29, 2018 bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular prognathism or retrognathism. The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone. Decompression or marsupialization technique for managing large odontogen. Sagittal split osteotomy and mandibular advancement. Bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular prognathism or retrognathism. A new hybrid technique for performing a safer bilateral sagittal. Bilateral sagittal split osteotomy jefferson university. The relationship between neurosensory disturbance of the. Bilateral sagittal split osteotomy bsso is a widely used orthognathic surgical. A bsso is performed behind the back teeth and then the jaw is. Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures.
Abstract the bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry. Bilateral sagittal split osteotomy bsso and distraction osteogenesis do are the most common techniques currently applied to surgically correct mandibular. A bilateral sagittal split osteotomy is a type of jaw surgery in which the lower jaw mandible is split bilaterally moved forward or backward to straighten it to a more balanced and functional position. In 1953, the sagittal split osteotomy evolved into a procedure that could be accomplished intraorally, without transfacial approaches and without leaving visible scars. Neurosensory disturbance is a common complication of bilateral sagittal split osteotomy bsso. Stability after bilateral sagittal split osteotomy. This technique was carried out via an intraoral approach and introduced the. Maxilla osteotomy upper jaw this procedure is intended for patients with an upper jaw deformity, or with an open bite. Operating on the upper jaw requires surgeons to make incisions below both eye sockets, making it a bilateral osteotomy, enabling the whole upper jaw, along with the roof of the mouth and upper teeth, to move as one unit. Complications of bilateral sagittal split osteotomy in patients with mandibular prognathism.
Oct 07, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Three lateral osteotomy designs for bilateral sagittal split. Bilateral sagittal split osteotomy europe pmc article. Bilateral sagittal split osteotomy bsso, according to obwegeser and dal pont, is a wellestablished method in maxillofacial surgery and probably the most frequently used technique for total osteotomy of the mandible. Introduction along with great increase in our knowledge over maxillofacial abnormalities and their surgical treatment during the recent decades, mandibular osteotomy. Mandibular sagittal split ramus osteotomy is the most common mandibular orthognathic procedure. Since its development, it has become the cornerstone of modern maxillofacial surgery and an important part of the everyday practice of many maxillofacial surgeons.
The objective of this study was to compare different bilateral sagittal split osteotomy bsso techniques to prevent the incidence of lower border mandibular defects. Modification of the mandibular split based on a physical. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy bony cuts 18. Complications of bilateral sagittal split osteotomy in. Bilateral sagittal split osteotomy bsso and intraoral vertical ramus osteotomy are currently the most preferred methods for correction of this condition. Relationship of the mandibular canal to the lateral cortex of the mandibular ramus as a factor in the development of neurosensory disturbance after bilateral sagittal split osteotomy. Request pdf bilateral sagittal split osteotomy the bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. Bilateral sagittal split osteotomy this adolescent male has always had a very prominent mandible. Bilateral sagittal split osteotomy bilateral sagittal split ramus osteotomy bsso is a common mandibular orthognathic procedure. However, the traditional design of buccal osteotomy, located at the junction of mandibular ramus and body, may prevent more extensive sliding between the bone segments, particularly on the advance, laterality and verticality of the mandibular body. Pdf most of the skeletal malocclusions which require orthognathic surgeries are treated by traditional approach which requires. He had a skeletal class iii malocclusion with an anterior crossbite of 9 mm. Mandibular osteotomies in orthognathic surgery of face. For the bilateral sagittal split osteotomy bsso, the chin and lip position are confirmed in the supine position.
Teachers at school had always complained that his speech was not clear. This article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. Surgical implications of the anatomic situation of the. The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone contact between the segments, and possibilities of osteosynthesis. The technique has been in practice since the late 1800s, but did not reach. Introduction during the recent decades the management of maxillofacial abnormalities has been improved. A bilateral sagittal split osteotomy bsso is a procedure used frequently for the correction of a class ii malocclusion. Modified mandibular sagittal split osteotomy request pdf. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. The modifications of the sagittal ramus split osteotomy. Compared to conventional bsso technique, less neurosensory complications, risk of condylar sagging and bad splitting are expected in suggested modification. The aim of this study was to investigate the situation of the ian in the area of the bsso in preoperative 158 cbct.
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