The aim of this study was to compare the fracture patterns after sagittal split osteotomy according to Obwegeser/Dal Pont (ODP) and Hunsuck/Epker (HE), as well as to investigate the relationship between lateral bone cut ending or angle and the incidence of unfavorable/bad splits. Postoperative cone-beam computed tomograms of 124 splits according to ODP and 60 according to HE were analyzed. ODP led to 75.8% and HE led to 60% lingual fractures with mandibular foramen contact. Horizontal fractures were found in 9.7% and 6.7%, respectively, and unfavorable/bad splits were found in 11.3% and 10%, respectively. The lateral osteotomy angle was 106.22° (SD 12.03)° for bad splits and 106.6° (SD 13.12)° for favorable splits. Correlations were found between favorable fracture patterns and split modifications and between buccal ending of the lateral bone cut and bad splits (p < 0.001). No relationship was observed between split modifications (p = 0.792) or the osteotomy angle (p = 0.937) and the incidence of unfavorable/bad splits. Split modifications had no influence on the incidence of unfavorable/bad splits, but the buccal ending of the lateral bone cut did have an influence. More lingual fractures with mandibular foramen contact are expected with the ODP modification. The osteotomy angle did not differ between favorable and bad splits.

Fracture patterns after bilateral sagittal split osteotomy of the mandibular ramus according to the Obwegeser/Dal Pont and Hunsuck/Epker modifications.

Introduction Aim of this study was 1) to evaluate long-term dental/skeletal stability in patients with mandibular retrognathia corrected by BSSO, and 2) to examine factors associated with relapse. Materials and methods Seventy-seven of initial 151 study cohort subjects who had undergone orthognathic surgery in 2007–2011 agreed to participate. Present paper presents data on dental/skeletal stability in 46 patients; 31 patients were excluded because of missing calibration indicator in one of the patients' pre-operative cephalometric radiographs, or because of pregnancy. Pre-operative (T1), post-operative (T2) and long-term follow-up (T3) radiographs and patient's files were used in the study. Results Based on overjet measurements, mean mandibular advancement was 5.7 mm and mean relapse 0.1 mm. Mean pre-operative overbite was 5.4 mm, reduction at surgery 3.4 mm and mean relapse 1.1 mm, a statistically significant change. Mean mandibular advancement measured from condyle tognathion (Co-Gn) was 6.5 mm. Relapse in Co-Gn was 1.6 mm on average, i.e., about 25% of the advancement. Amount of advancement, fixation method, patient's age or gender or orthodontist/surgeon experience did not have influence on relapse. Conclusions Mandibular advancement with BSSO in healthy Class II patients is considered a stable procedure. 25% skeletal relapse was found with clinically non-significant dental changes.

Long-term stability of mandibular advancement with bilateral sagittal split osteotomy.

The aim of this clinical analysis was to evaluate intraoperative and early postoperative complications as well as late findings and the overall patient satisfaction following orthognathic surgery. In a retrospective, cross-sectional study, 119 patients after orthognathic surgery were included. Surgical approaches were single bilateral sagittal split osteotomy (BSSO (n = 52)), single LeFort-I osteotomy (n = 5) and bimaxillary osteotomy (LeFort-I + BSSO (n = 62)). Intraoperative and early (0–4 weeks postoperative) complications were investigated retrospectively (n = 119), whereas late findings and quality of life were assessed via clinical follow-up and survey (mean: 59 months postoperative) on 48 patients. Bad split (n = 4/114) was the most common intraoperative complication followed by one case of severe bleeding. Regarding early postoperative complications, temporary damage of the inferior alveolar nerve after BSSO was most common (n = 33/114), followed by facial nerve dysfunction (n = 3), failed osteosynthesis (n = 2) and one case of postoperative dyspnoea. Permanent hypaesthesia of the lower lip was the most prevalent (n = 28/45(BSSO and LeFort-I + BSSO)) late finding with varying extent, followed by temporomandibular dysfunction (TMD) (n = 25/48). Skeletal relapse mostly occurred after class II treatment, followed by class III, posterior crossbite and open bite. Overall, the surgery improved the patients’ self-perception (85.4%), with 60.4% of patients opting for surgery again. Long-term complications after orthognathic surgery occurred more frequently than commonly described in the literature, and analyses of the quality of life show the need for more comprehensive preoperative patient education. Hypaesthesia of the lower lip presented less as complication but rather as side effect following BSSO. As orthognathic surgery is mostly elective, preoperative patient education is of pivotal importance and should include proactive risk stratification.

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Complications or rather side effects? Quantification of patient satisfaction and complications after orthognathic surgery-a retrospective, cross-sectional long-term analysis.

Patterns of lingual split and lateral bone cut end and their associations with neurosensory disturbance after bilateral sagittal split osteotomy

Evaluation of the lingual fracture patterns after bilateral sagittal split osteotomy according to Hunsuck/Epker modified by an additional inferior border osteotomy using a burr or ultrasonic device.

Orthognathic surgery has always been a classical focus of maxillofacial surgery. Since more than 100 years, various surgical techniques for mandibular repositioning have been developed and clinically tested. Since the establishment of plate and screw osteosynthesis, orthognathic surgery became more stable and safe. Nowadays, different surgical methods for mobilising the mandible are existing. This international multicenter analysis (n = 51 hospitals) is providing first evidence based data for the current use of different surgical methods. The dominating techniques were Obwegeser/dal Pont (61%) followed by Hunsuck/Epker (37%) and Perthes/Schlossmann (29%). The main osteosynthesis materials were plates (82%), bicortical screws (23.5%), or a combination of both (5.9%). 47% of all centers reported to use several surgical methods at the same time, depending on the anatomical problem and the surgeon's preference. This shows that different surgical methods seem to work as comparable, safe, and reliable procedures in everydays clinical practise. On this basis, further prospective studies could evaluate possible advantages for our patients.

Leonore Gmelin

Papers

Moving the mandible in orthognathic surgery – A multicenter analysis