The Presence of Mandibular Third Molars During Sagittal Split Osteotomies Does Not Increase the Risk of Complications
ABSTRACT The purpose of this study was to investigate prospectively the effects of the presence or absence of third molars during sagittal split osteotomies (SSOs) on the frequency of unfavorable fractures, degree of entrapment and manipulation of the inferior alveolar nerve (IAN), and procedural time.
The investigators designed and implemented a prospective cohort study and enrolled a sample composed of patients who underwent SSOs to correct mandibular deformities. The primary predictor variable was the status of the mandibular third molar at the time of SSO, and it was divided into 2 levels, present at the time of SSO (group I) or absent at the time of SSO (group II). The primary outcome variable was unfavorable splits. The secondary outcome variables were the degree of entrapment/manipulation of the IAN and the procedural time. Appropriate bivariate and multivariate statistics were computed, and the level of statistical significance was set at P < .05.
Six hundred seventy-seven SSOs were performed in 339 patients: group I consisted of 331 SSOs (mean age ± SD: 19.6 ± 7.4 yrs), and group II consisted of 346 SSOs (30.4 ± 12.1 yrs). The overall rate of unfavorable fractures was 3.1% (21 of 677), with frequencies of 2.4% (8 of 331) in group I, compared with 3.8% (13 of 346) in group II (P = .3). The rate of IAN entrapment in the proximal segment was significantly lower in group I (37.2%) than in group II (46.5%; P = .01). The degree of entrapment was also significantly more severe for group II (P < .001). Third molars increased procedural time by 1.7 minutes (P < .001).
The presence of third molars during SSOs is not associated with an increased frequency of unfavorable fractures. Concomitant third molar removal in SSOs also decreases proximal segment IAN entrapment but only slightly increases operating time.
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ABSTRACT: An unfavourable fracture, known as a bad split, is a common operative complication in bilateral sagittal split osteotomy (BSSO). The reported incidence ranges from 0.5 to 5.5%/site. Since 1994 we have used sagittal splitters and separators instead of chisels for BSSO in our clinic in an attempt to prevent postoperative hypoaesthesia. Theoretically an increased percentage of bad splits could be expected with this technique. In this retrospective study we aimed to find out the incidence of bad splits associated with BSSO done with splitters and separators. We also assessed the risk factors for bad splits. The study group comprised 427 consecutive patients among whom the incidence of bad splits was 2.0%/site, which is well within the reported range. The only predictive factor for a bad split was the removal of third molars at the same time as BSSO. There was no significant association between bad splits and age, sex, class of occlusion, or the experience of the surgeon. We think that doing a BSSO with splitters and separators instead of chisels does not increase the risk of a bad split, and is therefore safe with predictable results.British Journal of Oral and Maxillofacial Surgery 01/2013; 51(6). DOI:10.1016/j.bjoms.2012.10.009 · 1.13 Impact Factor
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ABSTRACT: Purpose We investigated the extent to which neurosensory disturbance (NSD) burdens bilateral sagittal split osteotomy (BSSO) patients one year postoperatively. An additional aim was to identify related factors. Materials and methods In this prospective study, the fate of the mandibular nerve during BSSO surgery was recorded. The predictor variable was the degree of nerve injury during BSSO, and the outcome variable the burden of NSD one year postoperatively. Statistics were computed and a p-value of < 0.05 was considered significant. Results Forty-one patients (27 females, average age 37 years) completed the study. Of these patients, 90.2% had NSD, but most (89.2%) were satisfied with the treatment and would choose it again. The burden of NSD was greater the more the nerve was manipulated during surgery. The four patients with visible nerve lacerations had severe NSD and were unsatisfied with the treatment at the endpoint. Conclusions Although NSD is frequent one year after BSSO, the majority of the patients are satisfied with the treatment. A risk for severe NSD or neuropathic pain does, however, exist in a small group of patients. These patients should be identified at an early stage so that proper medical and supportive treatment can be initiated. If necessary, a multidisciplinary pain center should be consulted. The importance of accurate patient information preoperatively cannot be overstated.Journal of Oral and Maxillofacial Surgery 10/2014; 72(10). DOI:10.1016/j.joms.2014.06.444 · 1.28 Impact Factor
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ABSTRACT: Timing of third molar removal in relation to bilateral sagittal split osteotomy (BSSO) is controversial, especially with regard to postoperative complications. We investigated the influence of mandibular third molar presence on complications after BSSO with sagittal splitters and separators, by a retrospective record review of 251 patients (502 surgical sites). Mandibular third molars were present during surgery at 169 sites and removed at least 6 months preoperatively in 333 sites. Bad splits occurred at 3.0 % (5/169) and 1.5% (5/333) of the respective sites. Presence of mandibular third molars significantly increased the risk of bad splits (OR 1.08, CI 1.02-1.13, p<0.01). The mean incidences of permanent neurosensory disturbances, postoperative infection, and symptomatic removal of the osteosynthesis material were 5.4% (OR, 0.89; 95% CI, 0.79- 1.00; p = 0.06), 8.2% (OR, 1.09; 95% CI, 0.99-1.20; p = 0.63), and 3.4% (OR, 0.97; 95% CI, 0.92-1.03; p = 0.35) per site, respectively, without a significant influence of mandibular third molar status. In conclusion, the presence of mandibular third molars during surgery increases the possibility of bad splits, but does not affect the risk of other complications. Therefore, third molars can be removed concomitantly with BSSO using sagittal splitters and separators.Journal of Cranio-Maxillofacial Surgery 10/2014; 42(7). DOI:10.1016/j.jcms.2014.03.019 · 2.60 Impact Factor