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Risk factors and prevention of bad splits during sagittal split osteotomy

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Abstract

Purpose

One of the operative complications of the sagittal split osteotomy of the mandible is a bad split, which describes an unfavorable or irregular fracture of the mandible in the course of the osteotomy. The purpose of this study is to identify previous studies which reported incidences of bad split occurrence during sagittal split osteotomy and to discuss its mechanisms and risk factors, based on a literature review, in order to minimize their occurrence. A few illustrative cases are also presented.

Methods

An electronic search was undertaken in January 2011. The titles and abstracts from these results (n = 363) were read for identifying studies which reported incidences of bad split occurrence during sagittal split osteotomy procedures.

Results

Twenty-one studies were identified and assessed. The incidence of bad splits from these studies varied between 0.21% and 22.72%. The buccal plate of the proximal segment and the posterior aspect of the distal segment were the most affected areas.

Discussion

The surgical patient should be evaluated according to age and the presence of unerupted/impacted third molars. Prevention is focused on adequate osteotomy design, eliminating sharp angle where abnormal stress occurs on bony segments, completion of adequate cuts into the retrolingular depression and through the inferior border, and careful separation of the segments. The SSO is an extremely technical and sensitive procedure, and careful attention will probably prevent most unfavorable splits. If a fracture occurs, the fractured segments should be incorporated into the fixation scheme if possible. The occurrence of bad splits cannot always be avoided. When adequately treated the chances of functional success are good.

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References

  1. Schuchart K (1942) Ein Beitrag zur chirurgischen Kieferorthopadie unter Berucksichtigung ihrer Bedeutung fur die Behandlung angeborener under worbener Kieferdeformitaten die Soldaten. Dtsch Zahn- Mund-Kieferhk 9:73–89

    Google Scholar 

  2. Trauner R, Obwegeser H (1955) Zur Operationstechnik bei der Progenie und anderen Unterkieferanomalien. Dtsch Zahn Mund Kieferheilk 23:11–26

    Google Scholar 

  3. Mathis H (1956) Über die Möglichkeit der rein enoralen Durchführung der beiderseitigen Osteotomie zur Behandlung der Progenie. Österr Z Stomat 53:362

    Google Scholar 

  4. Dal Pont G (1961) Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv 19:42–47

    PubMed  CAS  Google Scholar 

  5. Hunsuck EE (1968) A modified intraoral sagittal splitting technique for correction of mandibular prognathism. J Oral Maxillofac Surg 26:250–253

    CAS  Google Scholar 

  6. Epker BN (1977) Modifications in the sagittal osteotomy of the mandible. J Oral Surg 35:157–159

    PubMed  CAS  Google Scholar 

  7. Wolford LM, Bennett MA, Rafferty CG (1987) Modification of the mandibular ramus sagittal split osteotomy. Oral Surg Oral Med Oral Pathol 64:146–155

    Article  PubMed  CAS  Google Scholar 

  8. Loh FC (1992) Technical modification the sagittal split mandibular ramus osteotomy. Oral Surg Oral Med Oral Pathol 74:723–726

    Article  PubMed  CAS  Google Scholar 

  9. Marquez IM, Stella JP (1998) Modification of sagittal split ramus osteotomy to avoid unfavorable fracture around impacted third molars. Int J Adult Orthod Orthognath Surg 13:183–187

    CAS  Google Scholar 

  10. Teltzrow T, Kramer FJ, Schulze A, Baethge C, Brachvogel P (2005) Perioperative complications following sagittal split osteotomy of the mandible. J Craniomaxillofac Surg 33:307–313

    Article  PubMed  Google Scholar 

  11. Guernsey LH, DeChamplain RW (1971) Sequelae and complications of the intra oral sagittal osteotomy in the mandibular rami. Oral Surg Oral Med Oral Pathol 32:176–192

    Article  PubMed  CAS  Google Scholar 

  12. Behrman SJ (1972) Complications of sagittal osteotomy of the mandibular ramus. J Oral Surg 30:554–561

    PubMed  CAS  Google Scholar 

  13. Veras RB, Kriwalsky MS, Hoffmann S, Maurer P, Schubert J (2008) Functional and radiographic long-term results after bad split in orthognathic surgery. Int J Oral Maxillofac Surg 37:606–611

    Article  PubMed  CAS  Google Scholar 

  14. Turvey TA (1985) Intraoperative complications of sagittal osteotomy of the mandibular ramus: incidence and management. J Oral Maxillofac Surg 43:504–509

    Article  PubMed  CAS  Google Scholar 

  15. O’Ryan F (1990) Complications of orthognathic surgery. Oral Maxillofac Surg Clin North Am 2:593–601

    Google Scholar 

  16. Panula K, Finne K, Oikarinen K (2001) Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg 59:1128–1137

    Article  PubMed  CAS  Google Scholar 

  17. Martis CS (1984) Complications of mandibular sagittal split osteotomy. J Oral Maxillofac Surg 42:101–107

    Article  PubMed  CAS  Google Scholar 

  18. Akhtar S, Tuinzing DB (1999) Unfavorable splits in sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:267–268

    Article  PubMed  CAS  Google Scholar 

  19. Simpson W (1981) Problems encountered in the sagittal split operation. Int J Oral Surg 10:81–86

    Article  PubMed  CAS  Google Scholar 

  20. Epker BN, Fish LC (1986) Dentofacial Deformities: integrated Orthodontic and Surgical Correction. Vol. 1 St. Louis, CV Mosby, pp 232–234

  21. Mehra P, Castro V, Freitas RZ, Wolford LM (2001) Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars. J Oral Maxillofac Surg 59:854–859

    Article  PubMed  CAS  Google Scholar 

  22. van Merkesteyn JP, Groot RH, van Leeuwaarden R, Kroon FH (1987) Intraoperative complications in sagittal and vertical ramus osteotomies. Int J Oral Maxillofac Surg 16:665–670

    Article  PubMed  Google Scholar 

  23. el Deeb M, Wolford L, Bevis R (1989) Complications of orthognathic surgery. Clin Plast Surg 16:825–840

    PubMed  Google Scholar 

  24. Jönsson E, Svatrz K, Welander V (1979) Sagittal split technique. Part I. Immediate postoperative conditions: a radiographic follow-up study. Int J Oral Surg 8:75–81

    Article  PubMed  Google Scholar 

  25. MacIntosh RB (1981) Experience with the sagittal osteotomy of the mandibular ramus: a 13-year review. J Maxillofac Surg 9:151–165

    Article  PubMed  CAS  Google Scholar 

  26. Tucker MR (1995) Sagittal ramus osteotomy with and without third molars. J Oral Maxillofac Surg 53(suppl 4):80

    Google Scholar 

  27. Van de Perre JP, Stoelinga PJ, Blijdorp PA, Brouns JJ, Hoppenreijs TJ (1996) Perioperative morbidity in maxillofacial orthopaedic surgery: a retrospective study. J Craniomaxillofac Surg 24:263–270

    Article  PubMed  Google Scholar 

  28. Precious DS, Lung KE, Pynn BR, Goodday RH (1998) Presence of impacted teeth as a determining factor of unfavorable splits in 1256 sagittal split osteotomies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 85:362–365

    Article  PubMed  CAS  Google Scholar 

  29. Acebal-Bianco F, Vuylsteke PL, Mommaerts MY, De Clercq CA (2000) Perioperative complications in corrective facial orthopedic surgery: a 5-year retrospective study. J Oral Maxillofac Surg 58:754–760

    Article  PubMed  CAS  Google Scholar 

  30. Maurer P, Otto C, Eckert AW, Schubert J (2001) Komplikationen bei der chirurgischen Behandlung von Dysgnathien-ein 50 jähriger Behandlungsbericht. Mund Kiefer Gesichtschir 5:357–361

    PubMed  CAS  Google Scholar 

  31. Reyneke JP, Tsakiris P, Becker P (2002) Age as a factor in the complication rate after removal of unerupted/impacted third molars at the time of mandibular sagittal split osteotomy. J Oral Maxillofac Surg 60:654–659

    Article  PubMed  Google Scholar 

  32. Kim SG, Park SS (2007) Incidence of complications and problems related to orthognathic surgery. J Oral Maxillofac Surg 65:2438–2444

    Article  PubMed  Google Scholar 

  33. Kriwalsky MS, Maurer P, Veras RB, Eckert AW, Schubert J (2008) Risk factors for a bad split during sagittal split osteotomy. Br J Oral Maxillofac Surg 46:177–179

    Article  PubMed  Google Scholar 

  34. Falter B, Schepers S, Vrielinck L, Lambrichts I, Thijs H, Politis C (2010) Occurrence of bad splits during sagittal split osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 110:430–435

    Article  PubMed  Google Scholar 

  35. Schubert W, Kobienia BJ, Pollock RA (1997) Cross-sectional area of the mandible. J Oral Maxillofac Surg 55:689–692, discussion 693

    Article  PubMed  CAS  Google Scholar 

  36. Schwartz H (2002) The timing of third molar removal in patients undergoing a bilateral sagittal split osteotomy. J Oral Maxillofac Surg 60:132–133

    PubMed  Google Scholar 

  37. Jones TA, Garg T, Monaghan A (2004) Removal of a deeply impacted mandibular third molar through a sagittal split ramus osteotomy approach. Br J Oral Maxillofac Surg 42:365–368

    Article  PubMed  Google Scholar 

  38. Precious DS (2004) Removal of third molars with sagittal split osteotomies: the case for. J Oral Maxillofac Surg 62:1144–1146

    Article  PubMed  Google Scholar 

  39. Gil JN, Marin C, Claus JD, Lima SM Jr (2007) Modified osteotome for inferior border sagittal split osteotomy. J Oral Maxillofac Surg 65:1840–1842

    Article  PubMed  Google Scholar 

  40. Nagakawa K, Ueki K, Matsumoto N, Takatsuka S, Yamamoto E, Ooe H (1997) The assessment of trigeminal nerve paresthesia after bilateral sagittal split osteotomy: modified somatosensory evoked potentials recording methods. J Cranio Maxillofac Surg 25:97–101

    Article  Google Scholar 

  41. Joss CU, Vassalli IM (2009) Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. J Oral Maxillofac Surg 67:301–313

    Article  PubMed  Google Scholar 

  42. Tucker MR (2004) Prevention and management of bad splits in sagittal split osteotomies. J Oral Maxillofac Surg 62(suppl 1):14

    Article  Google Scholar 

  43. Mommaerts MY (1992) Two similar ‘bad splits’ and how they were treated. Report of two cases. Int J Oral Maxillofac Surg 21:331–332

    Article  PubMed  CAS  Google Scholar 

  44. Patterson AL, Bagby SK (1999) Posterior vertical body osteotomy (PVBO): a predictable rescue procedure for proximal segment fracture during sagittal split ramus osteotomy of the mandible. J Oral Maxillofac Surg 57:475–477

    Article  PubMed  CAS  Google Scholar 

  45. O’Ryan F, Poor DB (2004) Completing sagittal split osteotomy of the mandible after fracture of the buccal plate. J Oral Maxillofac Surg 62:1175–1176

    Article  PubMed  Google Scholar 

  46. Duguet V, Precious DS, Clinton R (1987) Clivage sagittal des branches montantes mandibulaires: prevention des tranmatismes du pedicule dentaire inferieur. Rev Stomatol Chir Maxillofac 88:71–76

    PubMed  CAS  Google Scholar 

  47. Simpson W (1972) The short lingual cut in the sagittal osteotomy. J Oral Surg 30:811–812

    PubMed  CAS  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Av. Raja Gabaglia 1000/1209, Gutierrez, Belo Horizonte, MG CEP 30441-070, Brazil

    Bruno Ramos Chrcanovic

  2. Av. do Contorno 4747/1010, Serra, Belo Horizonte, MG-CEP 30110-921, Brazil

    Belini Freire-Maia

  3. Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica De Minas Gerais, Belo Horizonte, Brazil

    Bruno Ramos Chrcanovic & Belini Freire-Maia

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  1. Bruno Ramos Chrcanovic
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  2. Belini Freire-Maia
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Correspondence to Bruno Ramos Chrcanovic.

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Chrcanovic, B.R., Freire-Maia, B. Risk factors and prevention of bad splits during sagittal split osteotomy. Oral Maxillofac Surg 16, 19–27 (2012). https://doi.org/10.1007/s10006-011-0287-4

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