Advertisement

Ultrasonic vertical osteotomy of the distal segment for safe elimination of interference between the proximal and distal segments in bilateral sagittal split osteotomy for mandibular asymmetry

      Bilateral sagittal split osteotomy (BSSO) is commonly used in the correction of dentofacial deformities. However, in cases of facial asymmetry with a shift of the mandibular midline or occlusal cant, the condyle is displaced laterally by the pulling of the proximal segment medially when there is bony interference between the proximal and distal segments after the osteotomy. When the gap between the proximal and distal segments is large, the proximal segment will clearly be asymmetrical as a lateral bulge on the patient's cheek, even if a large piece is removed. To overcome these problems, Ellis reported a vertical osteotomy of the distal segment behind the terminal molar to passively align the segments of the sagittal ramus osteotomy.
      • Ellis III, E.
      A method to passively align the sagittal ramus osteotomy segments.
      This procedure can also be used to improve the angle of the occlusal plane and occlusal stability when rotating the maxillomandibular complex counterclockwise.
      • Ricard D.
      • Ferri J.
      Modification of the sagittal split osteotomy of the mandibular ramus: mobilizing vertical osteotomy of the internal ramus segment.
      When the inferior alveolar nerve (IAN) is exposed, it is retracted laterally and the vertical osteotomy made. However, the IAN is not always exposed because surgeons seek to minimise its exposure to prevent injury. As there is the potential for such injury during vertical osteotomy of the distal segment when a conventional bur or saw is used, we have developed an ultrasonic vertical osteotomy of the distal segment to eliminate interference safely between the proximal and distal segments of BSSO for mandibular asymmetry.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ellis III, E.
        A method to passively align the sagittal ramus osteotomy segments.
        J Oral Maxillofac Surg. 2007; 65: 2125-2130
        • Ricard D.
        • Ferri J.
        Modification of the sagittal split osteotomy of the mandibular ramus: mobilizing vertical osteotomy of the internal ramus segment.
        J Oral Maxillofac Surg. 2009; 67: 1691-1699
        • González-Garcia A.
        • Diniz-Freitas M.
        • Somaza-Martin M.
        • Garcia-Garcia A.
        Ultrasonic osteotomy in oral surgery and implantology.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 360-367
        • Pavliková G.
        • Foltán R.
        • Horká M.
        • Hanzelka T.
        • Borunska H.
        • Sedy J.
        Piezosurgery in oral and maxillofacial surgery.
        Int J Oral Maxillofac Surg. 2011; 40: 451-457
        • Ueki K.
        • Nakagawa K.
        • Marukawa K.
        • Yamamoto E.
        Le Fort I osteotomy using a ultrasonic bone curette to fracture the pterygoid plates.
        J Craniomaxillofac Surg. 2004; 32: 381-386