Comparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy

doi:10.1067/moe.2002.122639

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 93, Issue 6, June 2002, Pages 736-742

https://doi.org/10.1067/moe.2002.122639 Get rights and content

Abstract

Objective. Panoramic radiographs, computerized tomography (CT), and conventional spiral tomographic (Scanora, Soredex, Helsinki, Finland) radiographs were compared for their ability to locate the mandibular canal in the buccolingual direction. Furthermore, the relationship between the cortication of the mandibular canal in panoramic radiographs and the location of the canal in both computerized and conventional tomographic radiographs was assessed. Study design. The buccolingual location of the mandibular canal was determined bilaterally in twenty consecutive patients scheduled for bilateral sagittal split osteotomy. The position of the mandibular canal was evaluated by means of panoramic radiography, Scanora, and CT. The three imaging methods were compared for their ability to locate the mandibular canal in the buccolingual direction. The subjective neurosensory deficit of the lower lip and chin on both sides was registered preoperatively and at 4 days, 3 weeks, and 3 months after surgery, and the operative outcome was analyzed in relation to the distance from the mandibular canal to the buccal cortex of the mandible. Results. CT gave better visualization of the mandibular canal than Scanora imaging. Cortication of the mandibular canal on the panoramic radiograph did not serve as a predictor of the proximity of the mandibular canal to the cortices of the mandible. At 3-month follow-up, there were only eight operated sides with abnormal sensation of the lower lip and chin. In seven of these sides, the distance from the mandibular canal to the buccal cortex was less than 2 mm. Conclusion. The buccolingual location of the mandibular canal is visualized better with CT than with Scanora or panoramic radiographs. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:736-42)

Section snippets

Material and methods

Twenty consecutive patients scheduled for BSSO agreed to participate in this study, which was approved by the ethical committee at the University of Oulu, Oulu, Finland. Eleven of the patients were women and nine were men. Their ages ranged from 17 to 55 years, with a mean of 32 years. The indication for the operation was retrognathism in 16 cases and prognathism in 4. The operation was performed according to the Obwegeser-Dal Pont modification⁴ of the original method of sagittal split

Results

Altogether, 40 sides in 20 patients scheduled for BSSO were evaluated radiographically before surgery. Sensation in these 40 sides was self-evaluated and recorded at 4 days, 3 weeks, and 3 months after surgery. All patients had normal sensation in their chin and lip before the operation.

Our findings showed that it is possible to estimate the buccolingual location of the mandibular canal by means of CT more clearly than by conventional tomographic or panoramic radiography. On panoramic

Discussion

Mandibular orthognathic surgery may result in vascular and neurologic complications. To reduce these complications and to improve the quality of care, a well-planned surgical approach should include a proper anamnestic and clinical evaluation and selected radiographs that localize the anatomic structures in the surgical field. Image methods that provide precise localization of the mandibular canal and involve a minimal risk of exposure to ionizing radiation should be selected. This information

Conclusion

Locating the mandibular canal in the posterior region of the mandible is important before mandibular orthognathic surgery. However, the recommendations for the application of imaging techniques should be based on clinical necessity: the need for the portrayal of anatomic or topographic conditions, the ease of image production, the information expected from the image, the biologic risk for the patient, and financial considerations. Therefore, in principle, cross-sectional imaging should be

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The aim of this systematic review and meta-analysis was to assess whether the presence of inferior third molars during sagittal split mandibular ramus osteotomy increases the risk of intraoperative and postoperative complications. The PRISMA protocol was followed in this study, and the review was registered in the PROSPERO database (CRD42020147642). A search was conducted in the MEDLINE (PubMed), Web of Science, Cochrane Central, and Scopus databases on November 1, 2021. Nineteen articles were included, and the variables analysed were unfavourable fractures, infection, neurosensory disturbance, removal of osteosynthesis material, and duration of surgery. Meta-analyses were performed for the variables unfavourable fractures (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.58–1.57, P = 0.84), infection (RR 0.75, 95% CI 0.48–1.18, P = 0.21), and neurosensory disturbance (RR 1.55, 95% CI 0.61–3.91, P = 0.35); no statistically significant difference in the risk of these variables was found between the groups with and without third molars. The third molars did not increase the need to remove fixation material, but increased the surgery time. The presence of the third molar during sagittal split mandibular ramus osteotomy appears not to increase the risk of intraoperative and postoperative complications. The results presented here must be interpreted with caution due to the heterogeneity presented by the observational studies included.
Position of the mandibular canal before and after bilateral sagittal split ramus osteotomy: a cone beam computed tomographic study
2022, British Journal of Oral and Maxillofacial Surgery
The aim of this study was to evaluate the position of the mandibular canal (MC) before and after bilateral sagittal split ramus osteotomy (BSSRO) using cone-beam computed tomography (CT), and to compare the position of the MC in Class II and Class III patients in the preoperative period. Patients were divided into two groups: Class II (n = 38) and Class III (n = 41). Measurements of the superior, inferior, buccal, and lingual distances of the MC in relation to the cortical bone were taken at three levels in the proximal segment of the mandible. Results were analysed using the Kruskal–Wallis test (p < 0.05). In the Class II group the superior distance of the MC at levels 2 and 3, and the inferior distance at level 3 significantly decreased after BSSRO. In the Class III group, no significant differences were found at any level, and the inferior distances at all levels were smaller preoperatively than those in the Class II group. In the Class II group the position of the MC altered in relation to superior and inferior cortical bone after BSSRO. However, the position of the MC remained stable in the Class III group. Our results also suggest a deeper cut in inferior cortical bone in Class III patients.
Neurosensory Deficit Complications in Implant Dentistry
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Evaluation of the accuracy of linear measurements on multi-slice and cone beam computed tomography scans to detect the mandibular canal during bilateral sagittal split osteotomy of the mandible
2017, International Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Recent studies, however, have suggested that the use of CT scans offers better results in detecting the mandibular canal pathway when compared to conventional radiographs.6,13 As regards the accuracy of the different types of CT scan, studies have suggested that both CBCT and MSCT are adequate for use in the maxillofacial region.17,18,20,31,32 Both offer clear images of high contrast structures and are extremely useful in evaluating the bone structure.
The aim of this study was to compare the accuracy of linear measurements of the distance between the mandibular cortical bone and the mandibular canal using 64-detector multi-slice computed tomography (MSCT) and cone beam computed tomography (CBCT). It was sought to evaluate the reliability of these examinations in detecting the mandibular canal for use in bilateral sagittal split osteotomy (BSSO) planning. Eight dry human mandibles were studied. Three sites, corresponding to the lingula, the angle, and the body of the mandible, were selected. After the CT scans had been obtained, the mandibles were sectioned and the bone segments measured to obtain the actual measurements. On analysis, no statistically significant difference was found between the measurements obtained through MSCT and CBCT, or when comparing the measurements from these scans with the actual measurements. It is concluded that the images obtained by CT scan, both 64-detector multi-slice and cone beam, can be used to obtain accurate linear measurements to locate the mandibular canal for preoperative planning of BSSO. The ability to correctly locate the mandibular canal during BSSO will reduce the occurrence of neurosensory disturbances in the postoperative period.
Rare case of inferior alveolar nerve buccal fenestration
2016, Revista Portuguesa de Estomatologia, Medicina Dentaria e Cirurgia Maxilofacial
It has been related that only 7% of MCs are in contact with the mandible buccal cortex. This case report illustrates one mandibular canal with an atypical trajectory with fenestration at the buccal mandible cortex through a cone beam computed tomography exam from a 45 years old, Caucasian female patient, through ICat Vision^® (Imaging Science International, Hatfield, PA) and InVivo software (Dental Anatomage, Version 5.1.10). This anatomic variation was not observed in the left side. Preoperative planning should consider a well-recommended cone beam computed tomography, which will allow identification of trajectory variations that are not visualized in panoramic radiographs.
São descritos que apenas 7% dos MC estão em contato com o cortical bucal mandibular. Este relato de caso ilustra um canal mandibular com trajetória atípica e fenestração na cortical bucal da mandíbula, através de um exame de tomografia computadorizada de feixe cónico em paciente, mulher, 45 anos de idade, leucoderma, obtido por ICAT Vision^® (Imaging Science International, Hatfield, PA) e software InVivo (Dental Anatomage, versão 5.1.10). Esta variação anatómica não foi observada no lado esquerdo. O planeamento pré-operatório deve considerar a indicação da tomografia computadorizada de feixe cônico, o que irá permitir a identificação de variações de trajetória que não são visualizadas em radiografias panorâmicas.
Influence of osteotomy procedure and surgical experience on early complications after orthognathic surgery in the mandible
2014, Journal of Cranio-Maxillofacial Surgery
This study evaluated the influence of osteotomy procedure and surgical experience on early complication rates following orthognathic surgery in the mandible.
In a retrospective study, patients who underwent a mandibular osteotomy (Obwegeser–Dal Pont (ODP) and Hunsuk–Epker (HE)) were included. Incidence of “bad splits”, “bleeding episodes”, “delayed wound healing”, “failed osteosynthesis” and “nerve lesions” at 2 months post-operatively were recorded. Surgical experience was classified as: beginner (<10), intermediate (10–40) and expert (>40). Complications were correlated to the surgical approach and the experience level of the surgeon.
400 patients were included. 200 underwent a bimaxillary approach. 186 patients were operated using the ODP technique, 214 according to HE. Multivariate analysis confirmed significantly more unwanted fractures and bleeding events for ODP when compared to HE (p = 0.28, p = 0.003). Experienced surgeons had more osteosynthesis failures (0.047) and significantly more nerve lesions than the other groups (p = 0.01).
The HE osteotomy showed a more reliable fracture mechanism with less relevant bleeding episodes. Differences between the surgeons of varying training status were marginal with exception of a higher rate of osteosynthesis failure and temporary hypoesthesia in the experienced group.

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^*: ^aAssistant Professor of Oral Surgery, Institute of Dentistry, University of Oulu, and Oral and Maxillofacial Department, Oulu University Hospital, Finland.

^**: ^bPostgraduate Student, Institute of Dentistry, University of Oulu, Finland.

^*: ^cResident in Oral Radiology, Department of Diagnostics and Oral Medicine, Institute of Dentistry, University of Oulu, and Oral and Maxillofacial Department, Oulu University Hospital, Finland.

^**: ^dAssistant Professor of Oral Radiology, Department of Diagnostics and Oral Medicine, Institute of Dentistry, University of Oulu.

^*: ^eFormerly, Professor and Acting Head, Institute of Dentistry, University of Oulu; Currently, Faculty of Dentistry, Kuwait University, Kuwait.

^**: Source of funding for research: Oulu University Hospital.

^♦: Reprints requests: Leena Ylikontiola, DDS, Institute of Dentistry, Department of Oral and Maxillofacial Surgery, PL 5281, FIN-90014, University of Oulu, Finland, [email protected]

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Oral and Maxillofacial RadiologyComparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy*,**,*,**,*,**,♦

Abstract

Section snippets

Material and methods

Results

Discussion

Conclusion

Oral Surg

Oral Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Maxillofac Surg

J Oral Maxillofac Surg

Br J Oral Maxillofac Surg

J Maxillofac Surg

J Oral Maxillofac Surg

Int J Oral Maxillofac Surg

J Dent

Oral Surg Oral Med Oral Pathol

J Endod

Int J Oral Maxillofac Surg

Ein Betrag zur chirurgischen Kieferorthopädie unter Beruckssichtigung ihrer Bedeutung fur die Behandlung angeborener und erworbener Kieferdeformit'e4ten bei Soldaten

Dtsch Zahn Mund Kieferheilkd Zentralbl

Retromolar osteotomy for correction of prognathism

J Oral Surg Anesth Hosp D Serv

A modified intraoral sagittal splitting technique for correction of mandibular prognathism

J Oral Maxillofac Surg

Modification of the sagittal ramus split osteotomy for retrognathia

J Oral Surg

Modifications in the sagittal osteotomy of the mandible

J Oral Surg

Complications of sagittal osteotomy of the mandibular ramus

J Oral Surg

Evaluation of sagittal split ramus osteotomy in 17 patients

J Oral Surg

Analysis of postsurgical neurologic alteration in the trigeminal nerve

J Oral Surg

Oral and Maxillofacial Radiology
Comparison of three radiographic methods used to locate the mandibular canal in the buccolingual direction before bilateral sagittal split osteotomy*,**,*,**,*,**,♦