Currently, bilateral sagittal split osteotomy bssois the most commonly performed orthognathic surgical procedure. Bilateral sagittal spilt osteotomy and genioplasty in patient with lymphatic malformation video type. Ferretti, intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy,british journal of oral and maxillofacial surgery 2002 40, 285292. Mar, 2007 sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. This would result in perfect occlusion of the teeth along with establishment of a pleasing facial profile. Bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular prognathism or retrognathism. Intraoperative view of the guide positioning the segments and fixated to the proximal segment with single monocortical screw fixation.
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. Lefort 1 osteotomy during this part of the surgery, the upper jaw is removed and repositioned in order to correct a maxillary deformity. Facial asymmetry surgery with bilateral sagittal split osteotomy, mandibular prognathism is a protrusion of the mandible in relation to the rest of the face the patient is a 20yearold female from kottayam in kerala, india who has a disproportionately large lower jaw. Ferretti, intraoperative diagnosis of condylar sag after bilateral sagittal split ramus osteotomy,british journal of oral and maxillofacial surgery 2002 40, 285292 58. 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. Sagittal split osteotomy definition of sagittal split. Facial asymmetry surgery, bilateral sagittal split osteotomy. Following this, flaps were elevated and bone cuts were made in the mandible. Bilateral sagittal split osteotomy bsso is the main surgical tool for correcting skeletal discrepancies in the lower face patel and novia 2007. The sagittal split osteotomy obwegeserdal pont bellepker procedure 20.
The mandibular ramus sagittal osteotomy is a usual procedure used to correct deformities of the lower third of the face. The bilateral sagittal split osteotomy and osseous genioplasty an animation by sara egner this animation was created with mimics, 3dsmax, after effects and. Bilateral sagittal split osteotomy in a mandible, previously. Bilateral sagittal spilt osteotomy and genioplasty in patient.
Bilateral sagittal spilt osteotomy and genioplasty in. Bilateral sagittal split osteotomy bsso is the most common orthognathic surgical procedure. Sagittal split osteotomy a surgical procedure resembling the. Mandibular osteotomies in orthognathic surgery of face slideshare. Micrognathia lower jaw hypoplasia bilateral sagittal split.
The bilateral sagittal split osteotomy is a orthognathic surgery technique regarding the splitting of the mandible on both sides in a sagittal direction on the ascending dental branches. Sagittal split ramal osteotomy an overview sciencedirect topics. Jul 23, 2019 under general anesthesia, incisions were made in mandibular retromolar region bilaterally. Techniques such as the le fort i, ii, iii osteotomies, segmental osteotomies of the maxilla, bilateral sagittal split osteotomy bsso, bilateral vertical osteotomy bvo genioplasty, segmental osteotomy of the mandible, and the chin wing osteotomy are described. This article describes the technique for the sagittal split mandibular ramus osteotomy in a stepbystep fashion with tips and traps with each step. Onestage technique for sagittal split ramus osteotomy combined. This osteotomy technique originally was described by trauner and obwegeser in 1957. Three lateral osteotomy designs for bilateral sagittal. A new hybrid technique for performing a safer bilateral sagittal split osteotomy. Standard le fort i, bilateral sagittal split osteotomies, and sliding genioplasty techniques are used type iia surgery is only performed early at the age of 4 and older, when there is a centric occlusioncentric relation shift of more than 5 mm. Bilateral sagittal split osteotomy bsso is the most common orthognathic surgical procedure 1.
Bilateral mandibular sagittal split osteotomy bsso. Case upper and lower jaw advancement cheek implants. Complications of bilateral sagittal split osteotomy in patients with mandibular prognathism majid eshghpour1, baratolah shaban1, reza shahakbari2, reza mahvelati shamsabadi3, amir hossein nejat4 1 dental research center, department of oral and maxillofacial surgery, faculty of dentistry, mashhad university of medical sciences, mashhad, iran. Is bilateral sagittal split osteotomy of the mandible with. Jawline contouring through an intraoral approach in the. Although the technique still presents a certain degree of technical difficulty, it has become a reliable procedure in orthognatic surgery. The bilateral sagittal split mandibular ramus osteotomy. Mohammad hassan samandari1, navid naghdi1 and milad etemadi sh1 1department of oral and maxillofacial surgery, school of dentistry, isfahan university of medical sciences, isfahan, iran. Sagittal split osteotomy, orthognathic jaw surgery for.
An osteotome and oscillating saw were used to perform this portion of the procedure. This technical note presents a noble and safe approach for medial osteotomy in bsso which is based on anatomy of mandible during the surgery. It is also mandatory that the surgical correction be performed accurately to ensure predictable and successful outcomes. The bone on the sagittal or side of the lower mandible of the jaw is cut on each side to form a split. 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. 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. Oct 07, 2014 the sagittal split osteotomy obwegeserdal pont bellepker procedure 20. Bilateral sagittal split osteotomy jefferson university. The influence of stripping the medial pterygoid muscle on proximal segment control for mandibular advancement procedures. Three lateral osteotomy designs for bilateral sagittal split osteotomy. 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. The bilateral sagittal split osteotomy and osseous genioplasty an animation by sara egner this animation was created with mimics, 3dsmax, after effects and final cut pro.
This study included ten patients who underwent bilateral sagittal split osteotomy procedure. Maxilla osteotomy upper jaw this procedure is intended for patients with an upper jaw deformity, or with an open bite. Bilateral sagittal split osteotomy bsso of the mandible is one of the most frequently performed surgical procedures. It was first described by trauner and obwegeser in 1957. Bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular deformities, such as mandibular prognathism or. One of the most sensitive stages in bsso is recognition of inferior alveolar nerve entrance. The technique has undergone numerous modifications. One of the goals during surgical repositioning of the mandible is to ensure a correct condylefossa relationship and to maintain the position of the proximal. The surgery may be either a single jaw maxilla or mandible or both jaws bimaxillary, with or without additional genioplasty, depending on the diagnosis and treatment plan for each patient.
Condylar sag central unilateral bilateral peripheral type i type ii types johan. Care was taken to ensure that the inferior alveolar nerve was in the distal segment. All patients were treated for orthognathic reasons. Bilateral sagittal split mandibular osteotomies for. In this paper, we share our experience on bssro with mandibular angle resection. Intraoperative computed tomography in bilateral sagittal. Jan 29, 2018 bilateral sagittal split ramus osteotomy bssro is commonly used to correct mandibular prognathism or retrognathism. Bilateral sagittal split osteotomy europe pmc article. 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.
Reports of bsso in a mandible, reconstructed with a nonvascularised bone. Assessment of nerve function after mandible surgery with a. This animation shows the results of a sagittal split osteotomy surgical procedure in which the mandible is moved into a more benefical position. However, previous studies only focused on single external forces on the mandible and did not conduct relevant research on the forces exerted by different occlusion. A modified novel technique for condylar positioning in.
It was then decided to perform obwegesers bilateral sagittal split osteotomy with a setback of 8 mm of the mandible. A sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. Lefort 1 osteotomy possible segmental and bilateral mandibular sagittal split osteotomy advancement what a mouthful. A bilateral sagittal split osteotomy technique modification. If the patient is exposed to excessive external forces after the procedure, occlusal changes or nonunion may occur. This allows the front part of the mandible to slide backward or forward until the teeth are aligned. Combining reciprocating saw and piezoelectric devices mirco raffaini, md, dds, phd1,2 raffaella perello, md3 marco conti, md, dds4 federico hernandezalfaro, md, dds, phd5 tommaso agostini, md4 1department of maxillofacial surgery, university of florence. Sagittal horizontal split osteotomy, as described by schuchardt. Biomechanical analysis of the forces exerted during different. Bilateral sagittal split osteotomy bsso the original bilateral ramus osteotomy by trauner and obwegeser 41 is performed in the ramus above the mandibular foramen. It is performed to correct types of malocclusion, a misalignment of teeth. Mar 26, 2010 bilateral sagittal split osteotomy bsso is the most common orthognathic surgical procedure. In 1961, dal pont7 advanced the lateral bone cut anteriorly towards the distal border of the second molar. Ac, osteotomy design of the bilateral sagittal split osteotomy from the medial, lateral, and inferior views, respectively.
Sagittal split osteotomy sso is a surgical technique largely employed for mandibular mobilizations in orthognatic procedures. Bilateral sagittal split osteotomy dr mathieu jacquemart lyon. 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. 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. Obwegesers bilateral sagittal split osteotomy was then performed. Complications of bilateral sagittal split osteotomy in. Three lateral osteotomy designs for bilateral sagittal split.
Assessment of three bilateral sagittal split osteotomy. This report describes a technique to suspend the submandibular space ss through an intraoral approach in the context of a bilateral sagittal split osteotomy bsso, thus improving the jawline contour and achieving a neckrejuvenating effect. Aug 31, 2016 bilateral sagittal spilt osteotomy and genioplasty in patient with lymphatic malformation video type. The bilateral sagittal split mandibular osteotomy bssmo, a common maxillofacial technique for expanding the oropharynx during treatment of micrognathia, is a rarely employed but useful adjunct to improve surgical access to the ventral cervical spine in children. Pdf the technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with. Bsso is often performed in young, otherwise healthy individuals as for orthognatic surgery in general, and there should therefore be a.
Since then, several modifications of the technique have been introduced with the aim of improving surgical convenience, minimizing morbidity, and maximizing procedural stability. The bilateral sagittal split osteotomy is an indispensable surgical procedure for the. Is bilateral sagittal split osteotomy of the mandible with n. The bilateral sagittal split osteotomy, or bsso for short, has evolved into an effective and preferred surgical procedure for mandibular advancement or setbacks. Nowadays bilateral sagittal split osteotomy bsso is the most common technique for treatment of mandibular skeletal deformities. Mar 16, 2020 a sagittal split osteotomy is an oral surgery procedure that is done to correct any serious misalignment of the upper and lower teeth. Engel, neurosensory alterations and function of the temporomandibular joint after high oblique sagittal split osteotomy. Bilateral sagittal split osteotomy pubmed central pmc. Mandibular osteotomies in orthognathic surgery of face.
It was first described by trauner and obwegeser in 1957 2. Jan 23, 2017 it is also mandatory that the surgical correction be performed accurately to ensure predictable and successful outcomes. Bilateral sagittal split mandibular ramus osteotomy. Hypoesthesia of the inferior alveolar nerve ian is a common. 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 lower jaw mandible is split and moved either backward or forward to straighten it into a more balanced position. The toothbearing middle section can then be moved forwards or backwards and then fixed immediately with surgical miniplates and screws. Mandibular sagittal split ramus osteotomy is the most common mandibular orthognathic procedure. Modifications of the procedure will be presented to avoid the presence of palpable gap at mandibular body, easily seen in greater movements. Mohammad hassan samandari 1, navid naghdi 1 and milad etemadi sh 1 1 department of oral and maxillofacial surgery, school of dentistry, isfahan university of medical sciences, isfahan, iran.
Jun 27, 2011 the bilateral sagittal split osteotomy and osseous genioplasty an animation by sara egner this animation was created with mimics, 3dsmax, after effects and final cut pro. Sagittal split osteotomy, as described by obwegeser. Patients with mandibular prognathism or retrognathism may also present with a. 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. For the bilateral sagittal split osteotomy bsso, the chin and lip position are confirmed in the supine position. The objective of the study was to show the importance of intraoperative computed tomography as an aid for ensuring inferior alveolar nerve safety during bilateral sagittal split osteotomy. Sagittal split ramal osteotomy an overview sciencedirect.
Cvideo 25 min videos of a particular surgery or technique. Bilateral sagittal split osteotomy bsso is an effective and commonly used treatment to correct mandibular hypo and hyperplasia. 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. The bilateral sagittal split osteotomy bsso technique is commonly used to correct mandibular deficiency.
Bilateral sagittal split osteotomy was performed using obwegesers technique. 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. Onestage technique for sagittal split ramus osteotomy. Bilateral ssaaggiittttaall sspplliitt oosstteeoottoommyy 25. A bilateral sagittal split osteotomy bsso is a procedure used frequently for the correction of a class ii malocclusion. Mar 27, 2020 meticulous treatment planning was performed for the patient. Patients with mandibular prognathism or retrognathism may also present with a prominent mandibular angle. The sagittal split osteotomy is one of the most commonly used procedures to correct a mandible retrusion overbite, or a mandibular prognathism underbite. 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. Neurosensory deficits after bilateral sagittal split osteotomy of the mandibleinfluence of sort tissue handling medial to the ascending ramus. Bilateral sagittal split osteotomy mandibular prognathism.
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