Advertisement

Risk factors for lower border notching after bilateral mandibular sagittal ramus advancement: three-dimensional evaluation

Published:September 14, 2022DOI:https://doi.org/10.1016/j.ijom.2022.08.020

      Abstract

      Bilateral sagittal split osteotomy (BSSO) mandibular advancement can cause mandibular lower border notching (MLBN). The objective of this study was to calculate the incidence of MLBN and identify risk factors. This single-centre, retrospective study was performed between January 2018 and November 2020, in the Maxillofacial Surgery Department, Centre Hospitalier Universitaire, Caen. Patients who underwent BSSO advancement and had cone beam computed tomography (CBCT) scans obtained preoperatively, immediately postoperative (within 1 week), and late postoperative (≥1 year) were included. Measurements were made on the CBCT images. A total of 113 patients (226 operated sides) were enrolled. Mean age at the time of surgery was 17 years; 66.4% of patients were female and 33.6% were male. MLBN was observed on 35 operated sides (15.5% of sides). Advanced age (P = 0.002) and the degree of mandibular advancement (P = 0.008) were determined to be risk factors for developing MLBN. Sex, the operated side, third molar removal, and genioplasty were not associated with an increased occurrence of MLBN. Older patient age at the time of surgery and the requirement for a large advancement should be taken into consideration by the surgeon in order to reduce the risk of MLBN by using a modified BSSO procedure or bone grafting.

      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 International 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

        • Trauner R.
        • Obwegeser H.
        The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty: Part I. Surgical procedures to correct mandibular prognathism and reshaping of the chin.
        Oral Surg Oral Med Oral Pathol. 1957; 10: 677-689https://doi.org/10.1016/S0030-4220(57)80063-2
        • Hunsuck E.E.
        A modified intraoral sagittal splitting technic for correction of mandibular prognathism.
        J Oral Surg. 1968; 26: 250-253
        • Epker B.N.
        Modifications in the sagittal osteotomy of the mandible.
        J Oral Surg. 1977; 35: 157-159
        • Verweij J.P.
        • Houppermans P.N.W.J.
        • Gooris P.
        • Mensink G.
        • van Merkesteyn J.P.R.
        Risk factors for common complications associated with bilateral sagittal split osteotomy: a literature review and meta-analysis.
        J Craniomaxillofac Surg. 2016; 44: 1170-1180https://doi.org/10.1016/j.jcms.2016.04.023
        • Agbaje J.O.
        • Sun Y.
        • Vrielinck L.
        • Schepers S.
        • Lambrichts I.
        • Politis C.
        Risk factors for the development of lower border defects after bilateral sagittal split osteotomy.
        J Oral Maxillofac Surg. 2013; 71: 588-596https://doi.org/10.1016/j.joms.2012.07.003
        • Verweij J.P.
        • van Rijssel J.G.
        • Fiocco M.
        • Mensink G.
        • Gooris P.J.J.
        • van Merkesteyn J.P.R.
        Are there risk factors for osseous mandibular inferior border defects after bilateral sagittal split osteotomy?.
        J Craniomaxillofac Surg. 2017; 45: 192-197https://doi.org/10.1016/j.jcms.2016.12.015
        • Delaire J.
        • Schendel S.A.
        • Tulasne J.F.
        An architectural and structural craniofacial analysis: a new lateral cephalometric analysis.
        Oral Surg Oral Med Oral Pathol. 1981; 52: 226-238https://doi.org/10.1016/0030-4220(81)90252-8
        • Veyssiere A.
        • Leprovost N.
        • Ambroise B.
        • Prévost R.
        • Chatellier A.
        • Bénateau H.
        Study of the mechanical reliability of an S-shaped adjustable osteosynthesis plate for bilateral sagittal split osteotomies. Study on 15 consecutive cases.
        J Stomatol Oral Maxillofac Surg. 2018; 119: 19-24https://doi.org/10.1016/j.jormas.2017.11.003
        • Cifuentes J.
        • Yanine N.
        • Jerez D.
        • Barrera A.
        • Agbaje J.
        • Politis C.
        Use of bone grafts or modified bilateral sagittal split osteotomy technique in large mandibular advancements reduces the risk of persisting mandibular inferior border defects.
        J Oral Maxillofac Surg. 2018; 76: 189.e1-189.e6https://doi.org/10.1016/j.joms.2017.09.002
        • Ueki K.
        • Moroi A.
        • Takayama A.
        • Saito Y.
        • Sato M.
        • Baba N.
        • Kimura Y.
        • Fujimoto K.
        • Koizumi M.
        • Hotta A.
        • Iguchi R.
        • Yoshizawa K.
        Computed tomography assessment of mandibular morphologic changes and the inferior mandibular border defect after sagittal split ramus osteotomy.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2021; 132: 496-505https://doi.org/10.1016/j.oooo.2021.02.010
        • Agbaje J.O.
        • Gemels B.
        • Salem A.S.
        • Anumendem D.
        • Vrielinck L.
        • Politis C.
        Modified mandibular inferior border sagittal split osteotomy reduces postoperative risk for developing inferior border defects.
        J Oral Maxillofac Surg. 2016; 74: 1062.e1-1062.e9https://doi.org/10.1016/j.joms.2016.01.005
        • Aalami O.O.
        • Nacamuli R.P.
        • Lenton K.A.
        • Cowan C.M.
        • Fang T.D.
        • Fong K.D.
        • Shi Y.Y.
        • Song H.M.
        • Sahar D.E.
        • Longaker M.T.
        Applications of a mouse model of calvarial healing: differences in regenerative abilities of juveniles and adults.
        Plast Reconstr Surg. 2004; 114: 713-720https://doi.org/10.1097/01.prs.0000131016.12754.30
        • Joss C.U.
        • Vassalli I.M.
        Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review.
        J Oral Maxillofac Surg. 2009; 67: 301-313https://doi.org/10.1016/j.joms.2008.06.060
        • Joos U.
        An adjustable bone fixation system for sagittal split ramus osteotomy: preliminary report.
        Br J Oral Maxillofac Surg. 1999; 37: 99-103https://doi.org/10.1054/bjom.1997.0081
        • Borstlap W.A.
        • Stoelinga P.J.W.
        • Hoppenreijs T.J.M.
        • van’t Hof M.A.
        Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part III—condylar remodelling and resorption.
        Int J Oral Maxillofac Surg. 2004; 33: 649-655https://doi.org/10.1016/j.ijom.2004.01.018
        • Trevisiol L.
        • Nocini P.F.
        • Albanese M.
        • Sbarbati A.
        • D’Agostino A.
        Grafting of large mandibular advancement with a collagen-coated bovine bone (Bio-Oss Collagen) in orthognathic surgery.
        J Craniofac Surg. 2012; 23: 1343-1348https://doi.org/10.1097/SCS.0b013e3182646c3a
        • Raffaini M.
        • Magri A.S.
        • Giuntini V.
        • Nieri M.
        • Pantani C.
        • Conti M.
        How to prevent mandibular lower border notching after bilateral sagittal split osteotomies for major advancements: analysis of 168 osteotomies.
        J Oral Maxillofac Surg. 2020; 78: 1620-1626https://doi.org/10.1016/j.joms.2020.04.036
        • Van der Helm H.C.
        • Kraeima J.
        • Xi T.
        • Jansma J.
        • Schepers R.H.
        The use of xenografts to prevent inferior border defects following bilateral sagittal split osteotomies: three-dimensional skeletal analysis using cone beam computed tomography.
        Int J Oral Maxillofac Surg. 2020; 49: 1029-1035https://doi.org/10.1016/j.ijom.2020.01.006
        • Coppey E.
        • Mommaerts M.Y.
        Early complications from the use of calcium phosphate paste in mandibular lengthening surgery. A retrospective study.
        J Oral Maxillofac Surg. 2017; 75: 1274.e1-1274.e10https://doi.org/10.1016/j.joms.2017.01.017
        • Wolford L.M.
        • Davis W.M.
        The mandibular inferior border split: a modification in the sagittal split osteotomy.
        J Oral Maxillofac Surg. 1990; 48: 92-94https://doi.org/10.1016/0278-2391(90)90190-d
        • Wolford L.M.
        Influence of osteotomy design on bilateral mandibular ramus sagittal split osteotomy.
        J Oral Maxillofac Surg. 2015; 73: 1994-2004https://doi.org/10.1016/j.joms.2015.03.023
        • Grimaud F.
        • Bertin H.
        • Fauvel F.
        • Corre P.
        • Perrin J.P.
        Vertical ramus elongation and mandibular advancement by endobuccal approach: presentation of a new osteotomy technique.
        J Stomatol Oral Maxillofac Surg. 2017; 118: 66-69https://doi.org/10.1016/j.jormas.2016.12.003
        • Loncle T.
        • Bontemps P.
        • Bénaicha M.
        Modified technique used for sagittal splitting of the mandible.
        J Stomatol Oral Maxillofac Surg. 2017; 118: 193-196https://doi.org/10.1016/j.jormas.2017.03.009
        • Maal T.J.J.
        • de Koning M.J.J.
        • Plooij J.M.
        • Verhamme L.M.
        • Rangel F.A.
        • Bergé S.J.
        • Borstlap W.A.
        One year postoperative hard and soft tissue volumetric changes after a BSSO mandibular advancement.
        Int J Oral Maxillofac Surg. 2012; 41: 1137-1145https://doi.org/10.1016/j.ijom.2012.04.004