A general survey of our experience with this surgical procedure in fortyone cases is also presented. Removal of deeply impacted mandibular molars by sagittal. Modifications of the procedure will be presented for advancement and setback of the mandible. Surgical procedures of mandibular sagittal split osteotomy on during mandibular sagittal split osteotomy, the lower jaw is removed. The modifications of the sagittal ramus split osteotomy.
Condylar sag is an immediate or late alteration in the position of the condylar process in the glenoid fossa after the fixation of the osteotomy. Modified bilateral sagittal split osteotomy for correction of severe anterior open bite. A bilateral sagittal split osteotomy bsso is a procedure used frequently for the correction of a class ii malocclusion. Bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular prognathism or retrognathism. Condylar positioning changes following unilateral sagittal split ramus osteotomy in patients with mandibular prognathism myungin kim, junhwa kim, seunggon jung, hongju park, heekyun oh, sunyoul ryu and minsuk kook abstract background. Intermaxillary fixation of the ivro was achieved by using orthodontic brackets and stainless steel wires 0. Neurosensory disturbance after bilateral sagittal split. Jan 25, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 6. This study was performed to evaluate threedimensional positional change of the condyle using.
Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures. During this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. Assessment of nerve function after mandible surgery with a modified bilateral sagittal split osteotomy technique the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Long term followup of the sagittal splitting technique for correction of mandibular prognathism. Since 1957, when it was introduced by trauner and obwegeser 1, 2, 3, it has undergone a number of modifications in surgical technique as well as fixation of the segments. Pdf in 1953, the sagittal ramus split osteotomy was introduced by obwegeser. Axial view of 3d planning showing no changes to the left ramus. Jan 23, 2017 this article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. Nowadays, the obwegeser, dal pont, and hunsuck modification is probably the most used bsso design. 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 done to either move the lower jaw and its attached teeth either forward or back to correct dentoalveolar deformities and bring the teeth into a better interdigitating relationship. Jaw angle bony deformity after sagittal split mandibular. Pdf stability of open bite correction with sagittal. Changes of transverse mandibular width in setback mandibular. May 06, 2014 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. Mandibular sagittal split ramus osteotomy is the most common mandibular orthognathic 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. Orthognathic jaw surgery is a reconstructive procedure and medically necessary and is considered covered when both the skeletal deformity and the functional im pairment criteria below are met. Jul 30, 2019 intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy. The sagittal ramus split osteotomy could be the procedure which defined the evolution of the specialty of oral surgery, the art, to the specialty of oral and. Original article photoelastic evaluation of two different. The influence of bilateral sagittal split ramus osteotomy.
Modified mandibular sagittal split osteotomy request pdf. Although there have been many modifications designed to improve the procedure, two of the earlier ones were suggested by hunsuck and dal pont. Sagittal split osteotomy was carried out virtually, and the fixation techniques were applied onto the model. Pdf the mandibular ramus sagittal osteotomy is a usual procedure used to correct deformities of the lower third of the face. Major advantages of this technique include controlled splitting of. Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction osteogenesis. For many years, and in some countries still, this technique has defined the term oral and maxillofacial surgery. A finite element analysis study comparing 3 internal fixation. Bilateral sagittal split osteotomy of mandible bsso is a surgical method used to correct the sagittal, transversal and vertical position of the lower jaw. A new technique for mandibular osteotomy springerlink. The original operation technique by obwegeser was shortly after improved by dal ponts modification. Sagittal split osteotomy, as described by obwegeser.
Factors affecting the stability of bilateral sagittal. Sagittal split osteotomy and mandibular advancement. Bilateral sagittal split osteotomy bsso is a well documented standardized and relatively safe operation to correct jaw deformities such as mandibular retrognathism. Three lateral osteotomy designs for bilateral sagittal. Bilateral sagittal split osteotomy bilateral sagittal split ramus osteotomy bsso is a common mandibular orthognathic procedure. Assessment of nerve function after mandible surgery with a. Mandibular osteotomy, orthognathic surgery, photoelastic model introduction the sagittal split ramus osteotomy ssro is a technique with a long history and broad application 1. Although the technique still presents a certain degree of technical difficulty, it has become a reliable procedure in orthognatic surgery.
In 1953, the sagittal ramus split osteotomy was introduced by obwegeser. The bilateral sagittal split osteotomy bsso is the mainstay of mandibular orthognathic surgical procedures. Bilateral sagittal split osteotomy pocket dentistry. Impacted third molars in sagittal split osteotomies in. The management of mandibular prognathism was revolutionized by the advent of the of sagittal split ramus osteotomy ssro technique as described by obwegesser and trauner in 1957. Anatomic study for the horizontal cut of the sagittal split. Sagittal split mandibular osteotomy definition of sagittal. Medial ramus, ascending ramus and inferior border osteotomies were performed and an osteotome at the inferior border was utilized to. For many years, and in some countries still, this technique has defined.
Sagittal horizontal split osteotomy, as described by schuchardt. Onestage technique for sagittal split ramus osteotomy. Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible. The original description of the bilateral sagittal split osteotomy bsso is credited to trauner and obwegeser.
A 3d virtual mandible model was constructed using images from ct scan. Threedimensional evaluation of lingual split line after. Lefort 1 osteotomy during this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. The aim of this study is to compare the differences in the stress distributions in the temporomandibular joints tmjs of the patients with facial asymmetry before and after bilateral sagittal split ramus osteotomy bssro under the symmetric occlusions using the threedimensional 3d finite element method ten facial asymmetry patients preoperative group, age 24. Bilateral sagittal split osteotomy bsso of the mandibular. The purpose of this study was to evaluate the mechanical behavior of the mandible and screwminiplate system among three lateral osteotomy designs for. The bone on the sagittal or side of the lower mandible of the jaw is cut on each side to form a split. The sagittal split osteotomy sso may prove to be a useful extraction method of deeply impacted mandibular molars due to its controlled manner of removing bone and its reduction of the risk of alveolar nerve damage via the direct identification of anatomic structures. Sagittal ramus split osteotomy british journal of oral and. Mar, 2007 sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. The procedure was initially described by hugo obwegeser in 1955 and remains an essential procedure in the plastic and maxillofacial surgeons surgical tool chest. The aim of this study was to analyse and compare the biomechanical properties of three internal fixation techniques 2. Condylar positioning changes following unilateral sagittal.
The sagittal ramus split osteotomy could be the procedure which defined the. Reconstruction of mandibular rami, horizontal, vertical, c, or l osteotomy. It is performed to correct types of malocclusion, a misalignment of teeth. The basic design of the sagittal ramus split surgical procedure evolved very quickly. This procedure is indicated for many deformities including mandibular hypoplasia, hyperplasia, and asymmetry. In 1961, dal pont7 advanced the lateral bone cut anteriorly towards the distal border of the second molar. A sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. Jul 16, 2012 this animation shows the results of a sagittal split osteotomy surgical procedure in which the mandible is moved into a more benefical position for the patient. Le fort osteotomy transverse sectioning and repositioning of the maxilla. The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks. Threedimensional evaluation of lingual split line after bilateral sagittal split osteotomy in asymmetric prognathism. This chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus. Sagittal split mandibular ramus osteotomy is one of the most frequently employed surgical procedures in orthognathic surgery, and is used to advance, setback. This technique provides a large area of contact between the bone fragments, improving surgical stability and bone healing, as well as the possibility of rigid internal.
Complications after mandibular sagittal split osteotomy journal of. To evaluate a method to identify condylar sag intraoperatively by clinical examination after bilateral sagittal split osteotomy bsso. Modified bilateral sagittal split osteotomy for correction. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Minimally invasive aesthetic and functional jaw surgery. Sagittal split osteotomy definition of sagittal split. Osteotomy of the mandibular ramus by bilateral sagittal split ramus osteotomy bssro, which was first introduced by trauner and obwegeser in 1957, is widely used to correct mandibular prognathism and retrognathism 1. Onestage technique for sagittal split ramus osteotomy combined. Sagittal split osteotomy sso was described by obwegeser et al in 19551 for the correction of both prognathism and mandibular deficiency. Pdf the modifications of the sagittal ramus split osteotomy. A finite element analysis study comparing 3 internal. Mandibular sagittal split osteotomy a modified technique to reduce.
Among the techniques used in correction surgeries of the mandible, the sagittal split ramus osteotomy ssro of the mandibular ramus is still the most frequently performed. Pdf is bilateral sagittal split osteotomy of the mandible with no. The presence of any of the following facial skeletal deformities associated with masticatory malocclusion. 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.
Bilateral sagittal split osteotomy bsso aims to correct congenital or acquired mandibular abnormities. 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. Ramus osteotomy ivsro, intergonial width, mandibular prognathism, inter ramal angle 1. Lefort 1 osteotomy possible segmental and bilateral mandibular sagittal split osteotomy advancement what a mouthful. The bilateral sagittal split osteotomy is an indispensable tool in the correction of dentofacial abnormalities. This procedure is versatile and can be used to achieve mandibular movements that include forward and backward sliding osteotomies, as well. Hugo obwegeser 21 october 1920 2 september 2017 was an austrian oral surgeon and plastic surgeon who is known as the father of the modern orthognathic surgery. Algorithm for the selection of the unilateral sagittal split ramus osteotomy protocol. Bilateral sagittal split osteotomy jefferson university. Reports of bsso in a mandible, reconstructed with a nonvascularised bone. Correlation between lingual split line pattern and the position of the lateral bone cut end group type i type ii type iiia type iiib type iv total type a. Osteosynthesis techniques used for mandibular sagittal. The present article introduces a statistical analysis of a surgical procedure, bilateral sagittal split osteotomy of the mandibular rami, which was performed at the university of minnesota hospital.
Temporary or permanent neurosensory disturbance is the most frequent complication of bsso. Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Several technical modifications based on the anatomical position of the neurovascular bundle and its bony mandibular canal have been developed, aiming to prevent injury to the intraalveolar nerve we hypothesized that the incidence of neurosensory disturbance nsd should be reduced using our bilateral sagittal split osteotomy bsso technique, because direct intraalveolar nerve injury can be. In my case, bone will be removed above the molars so that my top molars can finally rest comfortably atop my bottom molars and stop the pressure and grinding that is causing me pain and wearing out my molars. Modification of the mandibular ramus sagittal split osteotomy. The jaw is split into two sides and then screwed into the desired position.
Dec 31, 2016 this chapter details the bilateral sagittal split osteotomy bsso of the mandibular ramus. Comparison of three internal fixation techniques in. Pdf the technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with. Sagittal split ramal osteotomy an overview sciencedirect topics.
Intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy. Nevertheless, obwegesers technique occasionally is erroneously addressed as the obwegeserdal pont procedure. The aim of this study is to compare the differences in the stress distributions in the temporomandibular joints tmjs of the patients with facial asymmetry before and after bilateral sagittal split ramus osteotomy bssro under the symmetric occlusions using the threedimensional 3d finite element method. A modified intraoral sagittal splitting technique for correction of mandibular. Except for the advent of rigid fixation, for over 30 years there have been no improvements to this highly effective procedure. 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. Evaluation of the surgical procedure of sagittal split. A patient with mandibular hypoplasia and angles class ii malocclusion presented for a bilateral sagittal split osteotomy and genioplasty with genial tubercle advancement. The location of the lateral osteotomy cut during bilateral sagittal split osteotomy bsso varies according to the surgeons preference, and no consensus has been reached regarding the ideal location from the perspective of biomechanics. A new hybrid technique for performing a safer bilateral sagittal. This allows the front part of the mandible to slide backward or forward until the teeth are aligned.
The surgical procedure consists of bilateral osteotomies of the mandible, in which the angulus area is exposed by intraoral incisions and split in a near sagittal plane on both sides. Complications of bilateral sagittal split osteotomy in. In his publication of 1970, he was the first surgeon to describe the simultaneous procedure which involved surgeries of both maxilla and mandible involving le fort i and bilateral sagittal split osteotomy technique. Bilateral sagittal split ramus osteotomy an orthognathic surgery done at richardson dental and craniofacial hospital, nagercoil, tamilnadu, india. Faculty of dental medicine alazhar universityorthognathic surgery is the bilateral sagittal split osteotomy bsso has a wide range of. Mandibular sagittal split osteotomy orange county surgeons. This osteotomy technique originally was described by trauner and obwegeser in 1957.
The bilateral sagittal split mandibular ramus osteotomy. Lip paresthesia, mandibular prognathism, muscular function, sagittal split osteotomy. Osteosynthesis techniques used for mandibular sagittal split osteotomy history of orthognathic procedures and modern practice the idea of a direct internal osteosynthesis originated in maxillofacial traumatology, which in turn stemmed from orthopaedics. Its evolution has involved various modifications and the application. The timing of removal of mandibular third molars m3 in sagittal split osteotomy sso has been an issue of contention. Various internal fixation techniques are used in orthognathic surgery. Pdf risk factors for common complications associated with. Oct 07, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. The sagittal split osteotomy obwegeserdal pont bellepker procedure 6. The aim of this retrospective study is to identify the incidence of unfavorable fractures during sso with the presence of m3 and to identify the association between unfavorable fractures with the factors specifically related to the m3.