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Debraj Howlader, Dichen P Bhutia, U Vignesh, Divya Mehrotra
Facial asymmetry is one of the commonest facial anomalies, with reported incidence as high as 34%. Hemifacial microsomia (HFM) has an incidence of 1 in every 4000-5600 children and is one of the commonest causes of facial asymmetry. The standard treatment of HFM is orthognathic surgery by bilateral saggital split osteotomy (BSSO) or distraction osteogenesis (DO) of the mandible, both of which involve prolonged periods of occlusal adjustments by an orthodontist. Here, we present distraction of the mandible by means of a novel modified step osteotomy to correct the facial asymmetry in a case of hemifacial microsomia without disturbing the occlusion...
September 2016: Journal of Oral Biology and Craniofacial Research
J T Wes, P N W J Houppermans, J P Verweij, G Mensink, N Liberton, J P R van Merkesteyn
The bilateral sagittal osteotomy (BSSO) is a widely used surgical technique within orthognatic surgery. The specific osteotomy design may vary from clinic to clinic. The best position of the bone cuts in a BSSO continues to be a point of discussion and probably differs from patient to patient. In addition, standardisation in, for example, research may be desirable. Pre-operative planning using a drilling template in order to position the planned individual saw cuts during BSSO can be of value. To achieve this goal, a pre-operative 3D printed biocompatible drilling template was manufactured for 1 patient on the basis of pre-operative planning...
September 2016: Nederlands Tijdschrift Voor Tandheelkunde
Pascal N W J Houppermans, Jop P Verweij, Gertjan Mensink, Peter J J Gooris, J P Richard van Merkesteyn
Bilateral sagittal split osteotomy (BSSO) is a widely used orthognathic surgery technique. This prospective observational study investigated the correspondence between the planned inferior border cut and the actually executed inferior border cut during BSSO. The influence of the inferior border cut on lingual fracture patterns was also analyzed. Postoperative cone beam computed tomography (CBCT) scans of 41 patients, representing 82 sagittal split osteotomies, were investigated. The inferior border cut was intended to penetrate completely through the caudal cortex...
August 16, 2016: Journal of Cranio-maxillo-facial Surgery
Zhi Dai, Min Hou, Wen Ma, Da-Li Song, Chun-Xiang Zhang, Wei-Yuan Zhou
PURPOSE: To evaluate transverse displacement of the proximal segment after bilateral sagittal split ramus osteotomy (BSSO) advancement with different lingual split patterns and advancement amounts and to determine the influential factors related to mandibular width. MATERIALS AND METHODS: A 3-dimensional finite element model of the mandible including the temporomandibular joint was created for a presurgical simulation and for BSSO with lingual split patterns I (T1; Hunsuck split) and II (T2; Obwegeser split)...
July 25, 2016: Journal of Oral and Maxillofacial Surgery
Arif Razzak, Nabeela Ahmed, Andrew Sidebottom
Costochondral grafts are used to replace the mandibular condyle in cases of TMJ ankylosis, and are generally viewed as a gold standard for autogenous reconstruction of the mandibular condyle (Güven, 2000; Posnick and Goldstein, 1993 [1,2]). We report a case where overgrowth of costochondral grafts is seen, resulting in asymmetric mandibular growth and dentofacial asymmetry (Posnick and Goldstein, 1993 [2]). A 17 year old male patient presented with an existing costochondral graft performed due to TMJ ankylosis during childhood...
2016: International Journal of Surgery Case Reports
T Dreiseidler, J Bergmann, M Zirk, D Rothamel, J E Zöller, M Kreppel
The Obwegeser and Dal Pont modification of the bilateral sagittal split osteotomy (BSSO) is a well-established procedure in orthognathic surgery. The purpose of this retrospective study was to analyze the actual fracture patterns achieved with BSSO by Obwegeser and Dal Pont modification using postoperative cone beam computed tomography (CBCT) datasets from 100 patients. A total of 200 split osteotomies were assessed, which could be categorized into nine different split patterns. Only one of the observed split fractures (0...
June 28, 2016: International Journal of Oral and Maxillofacial Surgery
Sophia Mousoulea, Dimitrios Kloukos, Dimitrios Sampaziotis, Theodosia Vogiatzi, Theodore Eliades
OBJECTIVE: To systematically search the literature and assess the available evidence regarding the incidence and quantification of condylar resorption following bilateral sagittal split osteotomy (BSSO) of the mandible in orthognathic patients. SEARCH METHODS: Electronic database searches of published and unpublished literature were performed. The reference lists of eligible studies were hand searched for additional studies. SELECTION CRITERIA: Randomized clinical trials (RCTs), prospective, and retrospective studies with patients of any age that underwent BSSO were included...
June 22, 2016: European Journal of Orthodontics
K Andersen, M Thastum, S E Nørholt, J Blomlöf
The aim of this study was to investigate the length of stay (LOS) following orthognathic surgery and thereby to establish a benchmark. The secondary aim was to identify predictors of postoperative LOS following orthognathic surgery. Patients were treated consecutively during the period 2010 to 2012. Inclusion criteria were (1) patient age ≥18 years, and (2) surgery involving a three-piece Le Fort I osteotomy, or a bilateral sagittal split osteotomy (BSSO), or bimaxillary surgery. A total of 335 patients were included...
October 2016: International Journal of Oral and Maxillofacial Surgery
James Jeong, Jason E Portnof, Mona Kalayeh, Patrick Hardigan
UNLABELLED: Sevoflurane, an inhalational hypotensive anesthetic agent with a vasodilatory property, has been commonly used as a single agent to induce hypotension and effectively decrease blood loss in orthognathic surgery. However, it is common for patients to receive other hypotensive anesthetic agents in combination with sevoflurane. The purpose of our retrospective cohort study is to investigate whether administering an additional hypotensive agent has greater effect at reducing mean arterial pressure (MAP), estimated blood loss (EBL) and surgery time during orthognathic surgery...
July 2016: Journal of Cranio-maxillo-facial Surgery
E A Al-Moraissi, E A Al-Hendi
The objective of this study was to perform a systematic review and meta-analysis to test the null hypothesis that there is no difference in postoperative skeletal stability between bicortical screw and monocortical plate fixation after mandibular advancement surgery with bilateral sagittal split ramus osteotomy (BSSO). A comprehensive search of major databases (PubMed, EMBASE, and Cochrane CENTRAL) was conducted to locate all relevant articles published from inception to October 2015. Studies were selected based on inclusion criteria; randomized controlled trials, controlled clinical trials, and retrospective studies comparing bicortical screw vs...
October 2016: International Journal of Oral and Maxillofacial Surgery
Tung Nguyen, Ceib Phillips, Beatriz Paniagua
OBJECTIVE: To introduce new 3-D imaging techniques to characterize shape and volume changes of the oropharyngeal space after bilateral sagittal split osteotomy (BSSO) advancement. MATERIALS AND METHODS: Longitudinal cone-beam computed tomography (CBCT) scans were obtained for 20 patients undergoing BSSO advancement at three time points (T1 = presurgery, T2 = splint removal, and T3 = 1 year after surgery). Segmentation of the airway was performed using the following boundaries: hard palate/posterior nasal spine superiorly and lower border of C3 to the base of the epiglottis inferiorly...
May 3, 2016: Angle Orthodontist
Steven Rice, Paul Serrant, Sean Laverick, Grant McIntyre
To find out what consultants in Oral and Maxillofacial Surgery (OMFS) in the UK think about complications of bilateral sagittal split osteotomy (BSSO) in relation to lower third molars we organised a national postal questionnaire during 2012-13. Of 378 consultants, 192 practised orthognathic surgery of whom 132 replied (a 69% response rate). Eighty-one respondents routinely removed lower third molars before BSSO; 51 did not. Eighty-nine respondents thought that there was an increased risk of complications if third molars were present at the time of BSSO, mainly an increased risk of unfavourable fractures...
June 2016: British Journal of Oral & Maxillofacial Surgery
S A Steenen, A J van Wijk, A G Becking
An unfavourable and unanticipated pattern of the bilateral sagittal split osteotomy (BSSO) is generally referred to as a 'bad split'. Patient factors predictive of a bad split reported in the literature are controversial. Suggested risk factors are reviewed in this article. A systematic review was undertaken, yielding a total of 30 studies published between 1971 and 2015 reporting the incidence of bad split and patient age, and/or surgical technique employed, and/or the presence of third molars. These included 22 retrospective cohort studies, six prospective cohort studies, one matched-pair analysis, and one case series...
August 2016: International Journal of Oral and Maxillofacial Surgery
A Caillot, A Veyssière, A Chatellier, D Diep, A Ambroise, H Bénateau
INTRODUCTION: There is no recommendation concerning wisdom teeth (WT) extraction in mandibular orthognathic surgery. We carried out an investigation among the members of the French Society of Stomatology and Oro-maxillofacial Surgery (SFSCMFCO), in order to evaluate the practices and habits of maxillofacial surgeons in this field. MATERIALS AND METHODS: We emailed the 424 members of the SFSCMFCO with a questionnaire. RESULTS: We obtained 143 feedbacks that could be exploited...
June 2016: Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Marina Kuhlefelt, Pekka Laine, Hanna Thorén
OBJECTIVE: A prospective study to clarify the impact of forward bilateral sagittal split osteotomy (BSSO) on temporomandibular dysfunction (TMD). STUDY DESIGN: We examined and interviewed patients with BSSO before and at 1 year after surgery to evaluate the changes in TMD symptoms. A well-known TMD index, which incorporated two complementary subindices-the objective functional Helkimo dysfunction index (Di) and the subjective symptomatic anamnestic index (Ai)-was used...
June 2016: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Claudio Ungari, Emiliano Riccardi, Gabriele Reale, Alessandro Agrillo, Claudio Rinna, Valeria Mitro, Fabio Filiaci
AIM: The aim of this study was to determinate how orthognatic surgery aids to cure many skull and face abnormalities and to help re-establishing the correct occlusive relation thanks to the repositioning of the maxillo-mandibular skeleton basis. METHODS: The study included 183 male patients and 338 female patients, with an average age of 23 years. The sample series was divided according to specific pathologies. All patients underwent surgical procedures and the therapeutic strategy was determined based on the anomalies presented...
July 2015: Annali di Stomatologia
Toshinori Iwai, Susumu Omura, Koji Honda, Yosuke Yamashita, Naoki Shibutani, Koichi Fujita, Hikaru Takasu, Shogo Murata, Iwai Tohnai
Bimaxillary orthognathic surgery has been widely performed to achieve optimal functional and esthetic outcomes in patients with dentofacial deformity. Although Le Fort I osteotomy is generally performed before bilateral sagittal split osteotomy (BSSO) in the surgery, in several situations BSSO should be performed first. However, it is very difficult during bimaxillary orthognathic surgery to maintain an accurate centric relation of the condyle and decide the ideal vertical dimension from the skull base to the mandible...
February 17, 2016: Odontology
Stephan Christian Möhlhenrich, Mohammad Kamal, Florian Peters, Ulrike Fritz, Frank Hölzle, Ali Modabber
The most common way to move the mandible during orthognathic surgery is by bilateral sagittal split osteotomy (BSSO). The high-oblique sagittal split osteotomy (HSSO) is an alternative, although its use is limited by potential complications, mainly to do with the position of the condyle and reduced contact with bone. The aim of this study was to find out the optimal intercondylar distance and area of contact with the surface of the bone for mandibular advancement and setback in BSSO and HSSO. Data from computed tomographic (CT) images from 40 patients were loaded into special planning software, and virtual operations done for mandibular advancement and setback at 3, 5, 8, and 10mm using BSSO and HSSO, which resulted in 640 individual mandibular displacements...
April 2016: British Journal of Oral & Maxillofacial Surgery
J P Verweij, G Mensink, M Fiocco, J P R van Merkesteyn
This study aimed to investigate the incidence of neurosensory disturbance (NSD) after bilateral sagittal split osteotomy (BSSO) in different age groups and to assess the probability of sensory recovery in patients aged <19 years, 19-30 years, and >30 years. Hypoaesthesia of the lower lip was assessed subjectively and objectively immediately after BSSO and at 1 week and 1, 6, and 12 months after BSSO. Hypoaesthesia was considered permanent if it was present 1 year after BSSO. The frequency of NSD immediately after surgery was significantly higher in older patients...
July 2016: International Journal of Oral and Maxillofacial Surgery
I Méndez-Manjón, R Guijarro-Martínez, A Valls-Ontañón, F Hernández-Alfaro
The aim of this study was to perform a three-dimensional (3D) assessment of positional changes of the mandibular condyle after bilateral sagittal split osteotomy (BSSO). A prospective evaluation of 22 skeletal class II patients who underwent a BSSO for mandibular advancement was performed. Pre- and postoperative cone beam computed tomography scans were taken. Using the cranial base as a stable reference, the pre- and postoperative 3D skull models were superimposed virtually. Positional changes of the condyles were assessed with a 3D colour mapping system (SimPlant O&O)...
June 2016: International Journal of Oral and Maxillofacial Surgery
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