A New Hybrid Technique for Performing a Safer Bilateral Sagittal Split Osteotomy: Combining Reciprocating Saw and Piezoelectric Devices

Abstract

The sagittal split osteotomy (SSO) is an indispensable tool in the correction of dentofacial abnormalities. In elective orthognathic surgery, it is important that surgeons inform patients about the risk of complications related to inferior alveolar nerve damage and unfavorable split. The purpose of this article is to describe a novel, hybrid technique to SSO by combining a reciprocating saw and piezoelectric devices with several advantages over traditional “pure” methods (osteotomies performed by reciprocating saw or piezoelectric devices only) in terms of precision, rapidity, easier splitting, and decreased complications related to inferior alveolar nerve damage and bad split with reduced overall morbidity. The level of evidence was Level IV, therapeutic study.

Keywords

bilateral sagittal split osteotomy - osteotomy - bone - orthognathic surgery - bimaxillary - piezosurgery

Institution to Which the Work should be Attributed

Face Surgery Center, Via R. Bormioli 5/A, 43122 Parma (Italy)

• References

• 1 Trauner R, Obwegeser H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. I. Surgical procedures to correct mandibular prognathism and reshaping of the chin. Oral Surg Oral Med Oral Pathol 1957; 10 (07) 677-689
• 2 Hunsuck EE. A modified intraoral sagittal splitting technic for correction of mandibular prognathism. J Oral Surg 1968; 26 (04) 250-253
• 3 Epker BN. Modifications in the sagittal osteotomy of the mandible. J Oral Surg 1977; 35 (02) 157-159
• 4 Verweij JP, Houppermans PN, Gooris P, Mensink G, van Merkesteyn JP. Risk factors for common complications associated with bilateral sagittal split osteotomy: a literature review and meta-analysis. J Craniomaxillofac Surg 2016; 44 (09) 1170-1180
• 5 Landes CA, Stübinger S, Rieger J, Williger B, Ha TK, Sader R. Critical evaluation of piezoelectric osteotomy in orthognathic surgery: operative technique, blood loss, time requirement, nerve and vessel integrity. J Oral Maxillofac Surg 2008; 66 (04) 657-674
• 6 Raffaini M, Hernandez Alfaro F, Ghilardi R, Garcia Lopez A. The sagittal mandibular osteotomy under local anesthesia and intravenous sedation: four years of multicenter experience. Int J Adult Orthodon Orthognath Surg 2002; 17 (04) 267-271
• 7 Gateno J, Ferraz F, Alfi D. Bad split: anatomic or technical problem?. J Oral Maxillofac Surg 2015; 73 (06) 1023-1024
• 8 Phillips C, Essick G. Inferior alveolar nerve injury following orthognathic surgery: a review of assessment issues. J Oral Rehabil 2011; 38 (07) 547-554
• 9 Geha HJ, Gleizal AM, Nimeskern NJ, Beziat JL. Sensitivity of the inferior lip and chin following mandibular bilateral sagittal split osteotomy using Piezosurgery. Plast Reconstr Surg 2006; 118 (07) 1598-1607
• 10 Landes CA, Stübinger S, Ballon A, Sader R. Piezoosteotomy in orthognathic surgery versus conventional saw and chisel osteotomy. Oral Maxillofac Surg 2008; 12 (03) 139-147
• 11 Chrcanovic BR, Freire-Maia B. Risk factors and prevention of bad splits during sagittal split osteotomy. Oral Maxillofac Surg 2012; 16 (01) 19-27
• 12 Posnick JC, Choi E, Liu S. Occurrence of a ‘bad’ split and success of initial mandibular healing: a review of 524 sagittal ramus osteotomies in 262 patients. Int J Oral Maxillofac Surg 2016; 45 (10) 1187-1194
• 13 Al-Bishri A, Dahlberg G, Barghash Z, Rosenquist J, Sunzel B. Incidence of neurosensory disturbance after sagittal split osteotomy alone or combined with genioplasty. Br J Oral Maxillofac Surg 2004; 42 (02) 105-111
• 14 Agbaje JO, Salem AS, Lambrichts I, Jacobs R, Politis C. Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances. Int J Oral Maxillofac Surg 2015; 44 (04) 447-451