“What are Technique Considerations for the Bilateral Sagittal Split Osteotomy?”

7.7.24 Quick Review #170 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #BSSO #orthognathic #orthognathicsurgery 1. Preoperative Planning: • Cephalometric Analysis: Detailed analysis to determine the extent of setback required. • Model Surgery: Creating mock surgeries on dental models to plan the osteotomy and final occlusion. 2. Patient Positioning: • Proper patient positioning to ensure access and visibility, typically in a supine position with head extended. 3. Incision and Soft Tissue Management: • A careful mucosal incision is made to minimize tissue trauma. • Ensuring adequate exposure of the ramus and body of the mandible while preserving vital structures. 4. Osteotomy Technique: • The osteotomy is initiated at the buccal cortex of the ramus, extending anteriorly to the second molar region. • A vertical cut is made at the buccal cortex, followed by a horizontal cut along the inferior border. • The medial aspect of the ramus is also osteotomized, connecting the buccal cut with a lingual cut to complete the split. 5. Splitting the Mandible: • Careful splitting of the mandible using osteotomes and a mallet. The split should be gradual to avoid fracturing the lingual cortex. 6. Handling the Inferior Alveolar Nerve: • Extreme caution to avoid damaging the inferior alveolar nerve during the split and subsequent manipulation. Techniques and Key Movements: 1. Osteotomy Cuts: • Horizontal Cut: Made above the inferior alveolar nerve, typically starting from the anterior border of the ramus and extending posteriorly. • Vertical Cut: Extending from the buccal aspect to the medial aspect of the ramus. • Oblique Cut: This cut connects the horizontal and vertical cuts, facilitating a controlled split. 2. Mobilization and Positioning: • Controlled Mobilization: Gentle manipulation of the distal segment to ensure a clean separation. • Setback Movement: The distal segment is moved posteriorly to the predetermined position. 3. Fixation: • Rigid Fixation: Typically achieved using plates and screws to ensure stability of the segments. • Intermaxillary Fixation (IMF): Temporary fixation to maintain occlusion during the healing period. 4. Postoperative Care: • Monitoring for Complications: Including nerve damage, infection, and malocclusion. • Diet and Activity Restrictions: Soft diet and limited physical activity to promote healing. References: 1. AO Foundation. (n.d.). BSSO (Hunsuck). AO Surgery Reference. Retrieved July 6, 2024. 2. Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. (Eds.). (2022). Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.). Springer. 3. Ellis, E., Hupp, J. R., Tucker, M. R. (2018). Contemporary Oral and Maxillofacial Surgery (7th ed.). Elsevier. 4. Fonseca, R. J., Marciani, R. D., & Turvey, T. A. (Eds.). (2017). Oral and Maxillofacial Surgery (3rd ed.). Elsevier. 5. ChatGPT. 2024. - #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher