Abstract
The aim of this retrospective cohort study was to evaluate the relative amount of
cancellous bone in the mandibular ramus as a predictor of lingual fracture patterns
after bilateral sagittal split osteotomy (BSSO). The study including 78 consecutive
patients (156 osteotomy sites). In preoperative cone-beam computed tomographic (CT)
scans, the volumes of cancellous and cortical bone in the BSSO surgical field were
estimated. Patients were divided into two groups based on the cancellous:cortical
bone ratio. We studied postoperative cone-beam CT scans for lingual fracture lines
and subcategorised them according to the lingual split scale (LSS). Generalised linear
mixed models (GLMM) were estimated to evaluate the association between the cancellous:cortical
bone ratio and the lingual fracture pattern. There was a significant association between
the cancellous:cortical bone ratio of the mandibular angle and the lingual fracture
pattern after BSSO. Mandibular angles with a relatively small amount of cancellous
bone showed significantly more LSS3 fracture lines (OR = 1.990, 95%CI 1.043 to 3.796, p = 0.043). These mandibular angles also showed more unfavourable fractures (LSS4), although
this was not significant (OR = 2.352, 95%CI 0.748 to 7.392, p = 0.143). The relative amount of cancellous bone in the mandibular angle is significantly
associated with the lingual fracture line after BSSO.
Keywords
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References
- Risk factors for common complications associated with bilateral sagittal split osteotomy: a literature review and meta-analysis.J Craniomaxillofac Surg. 2016; 44: 1170-1180
- 3D evaluation of the lingual fracture line after a bilateral sagittal split osteotomy of the mandible.Int J Oral Maxillofac Surg. 2009; 38: 1244-1249
- Evaluation of the mandibular ramus fracture line after sagittal split ramus osteotomy using 3-dimensional computed tomography.J Oral Maxillofac Surg. 2012; 70: e648-52
- Three-dimensional evaluation of lingual split line after bilateral sagittal split osteotomy in asymmetric prognathism.J Korean Assoc Oral Maxillofac Surg. 2014; 40: 11-16
- Evaluation of the mandibular split patterns in sagittal split ramus osteotomy.J Oral Maxillofac Surg. 2015; 73: 985-993
- Three-dimensional fracture pattern analysis of the Obwegeser and Dal Pont bilateral sagittal split osteotomy.Int J Oral Maxillofac Surg. 2016; 45: 1452-1458
- Fracture patterns after bilateral sagittal split osteotomy of the mandibular ramus according to the Obwegeser/Dal Pont and Hunsuck/Epker modifications.J Craniomaxillofac Surg. 2017; 45: 762-767
- Angled osteotomy design aimed to influence the lingual fracture line in bilateral sagittal split osteotomy: a human cadaveric study.J Oral Maxillofac Surg. 2015; 73: 1983-1993
- A modified intraoral sagittal splitting technic for correction of mandibular prognathism.J Oral Surg. 1968; 26: 250-253
- Generalized linear models.2nd ed. Chapman and Hall, London1989
- Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars: its effect on the sagittal split ramus osteotomy.Int J Oral Maxillofac Surg. 2013; 42: 303-307
- Relationship between mandibular anatomy and the occurrence of a bad split upon sagittal split osteotomy.J Oral Maxillofac Surg. 2014; 72: 2508-2513
- Evaluation of mandibular anatomy associated with bad splits in sagittal split ramus osteotomy of mandible.J Craniofac Surg. 2016; 27: e500-4
- The inner osseous architecture and the sagittal splitting of the ascending ramus of the mandible.J Maxillofac Surg. 1973; 1: 171-176
- Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy.J Oral Maxillofac Surg. 1991; 49: 112-116
- Mandibular anatomy related to sagittal split ramus osteotomy in Koreans.Yonsei Med J. 1997; 38: 19-25
- Computed tomography morphology of the mandibular ramus in prognathism: effect on the medial osteotomy of the sagittal split ramus osteotomy.J Oral Maxillofac Surg. 2003; 61: 89-93
- Morphometric analysis of prognathic and non-prognathic mandibles in relation to BSSO sites using CBCT.J Oral Biol Craniofac Res. 2017; 7: 7-12
- Bilateral sagittal split osteotomy in cadaveric pig mandibles: evaluation of the lingual fracture line based on the use of splitters and separators.Oral Surg Oral Med Oral Pathol Oral Radiol. 2013; 116: 281-286
- Risk factors and prevention of bad splits during sagittal split osteotomy.Oral Maxillofac Surg. 2012; 16: 19-27
- Influence of osteotomy design on bilateral mandibular ramus sagittal split osteotomy.J Oral Maxillofac Surg. 2015; 73: 1994-2004
- Are there risk factors for osseous mandibular inferior border defects after bilateral sagittal split osteotomy?.J Craniomaxillofac Surg. 2017; 45: 192-197
- 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.Br J Oral Maxillofac Surg. 2013; 51: e192-4
- Three-dimensional computed tomographic evaluation of bilateral sagittal split osteotomy lingual fracture line and le fort I pterygomaxillary separation in orthognathic surgery using cadaver heads: ultrasonic osteotome versus conventional saw.J Oral Maxillofac Surg. 2015; 73: 1169-1180
Article info
Publication history
Published online: February 27, 2020
Accepted:
January 24,
2020
Received:
August 1,
2019
Identification
Copyright
© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
