Bad Split During Bilateral Sagittal Split Osteotomy of Mandible: Case Report
Bad Split During Bilateral Sagittal Split Osteotomy of Mandible: Case Report
Bilateral sagittal split osteotomy (BSSO) is a well-defined process that moves the mandible in three directions of space and
moves it into the correct position. BSSO has been described in the literature as a safe procedure. However, it includes some
intraoperative and postoperative complications. The most common of these is the bad split. The aim of this article is to present
bad splits cases and treatment methods. In our center had made 102 BSSO cases in 2012-2019 and 6 of these include bad split.
5 of these buccal plate fracture on proximal segment, one of these distal segment fracture include condyler process. All cases
had managed intraoperatively with screw osteosynthesis and no need for additional precaution like rigit intermaxillary fixation or
a prolonged stay. All patient were followed for 1 week, 1month, 6 month and 1 year. None of patient had showed poor function or
temporomandibular dysorder postoperatively.
Even if a bad split consist of during surgery, no influence final result or postoperative course.
Consequently, bad split is not avoidable all time. When treated well the chances of functional success are good.
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- 1. Travess H, Newton J, Sandy J. The development of a
patient-centered measure of theprocess and outcome of
combined orthodontic and orthognathic treatment. Journal
ofOrthodontics.2004;31(220).
- 2. FalterB, SchepersS, VrielinckL, LambrichtsI, ThijsH, PolitisC.
Occurrence of bad splits during sagittal split osteotomy.
Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology
and Endodontology. 2010;110(4):430-435.doi:10.1016/j.
tripleo.2010.02.003
- 3. Verweij JP, Houppermans PNWJ, Gooris P, Mensink G, van
Merkesteyn JPR. Riskfactors for common complications
associated with bilateral sagittal split osteotomy: Aliterature
review and meta-analysis. Journal of Cranio-Maxillofacial
Surgery.2016;44(9):1170-1180.doi:10.1016/j.jcms.2016.04.023
- 4. Jędrzejewski M, Smektała & T, Sporniak-Tutak & K, Olszewski &
R. Preoperative,intraoperative,and post operative complications
in orthognathic surgery:a systematic review.doi:10.1007/s00784-
015-1452-1
- 5. KimSG, ParkSS. Incidence of Complications and Problems
Related to Orthognathic Surgery. Journal of Oral and Maxillofacial
Surgery. 2007;65(12): 2438-2444.doi:10.1016/j.joms.2007.05.030
- 6. Mensink G, Verweij JP, Frank MD, Eelco Bergsma J, Richard
Van Merkesteyn JP.Bad split during bilateral sagittal split
osteotomy of the mandible with separators: Aretrospective
study of 427 patients. British Journal of Oral and Maxillofacial
Surgery.2013;51(6):525-529.doi:10.1016/j.bjoms.2012.10.009
- 7. Steenen S, Becking A. Bad splits in bilateral sagittal split
osteotomy: systematic reviewoff fracture patterns. International
Journal of Oral and Maxillofacial Surgery.2016;45(7):887-897.
- 8. Kriwalsky MS, Maurer P, Veras RB, Eckert AW, Schubert J. Risk
factors for a badsplit during sagittal split osteotomy. British
Journal of Oral and Maxillofacial Surgery.2008;46(3):177-179.
doi:10.1016/j.bjoms.2007.09.011
- 9. Reyneke JP, Tsakiris P, Becker P. Age as a factor in the
complication rate afterremoval ofunerupted/impacted third
molar sat the time of mandibular sagittal split osteotomy.
Journal of Oral and Maxillofacial Surgery. 2002;60(6):654-659.
doi:10.1053/joms.2002.33114
- 10. August M, Marchena J, Donagy J, Kaban L. Neurosensory
Deficit and Functional Impairment After Sagittal Ramus
Osteotomy:ALong-Term Follow-UpStudy.;1998.
- 11. Veras RB, Kriwalsky MS, Hoffmann S, Maurer P, Schubert
J. Functional and radiographic long-term results after bad split in orthognathic surgery. International Journal of Oral
and Maxillofacial Surgery. 2008;37(7):606-611.doi:10.1016/j.
ijom.2008.04.010