“Why is the Retrusive BSSO More Stable than the Protrusive BSSO?”

7.2.24 Quick Review #165 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #BSSO #orthognathics A bilateral sagittal split osteotomy (BSSO) is a common orthognathic surgical procedure used to correct mandibular deformities. The stability of the BSSO, whether retrusive (moving the mandible backward) or protrusive (moving the mandible forward), is influenced by several biomechanical and physiological factors. Stability of Retrusive vs. Protrusive BSSO: 1. Anatomical Considerations: • In a retrusive BSSO, the mandible is moved posteriorly, which typically results in a more stable bony overlap at the osteotomy site. This overlap provides better bone-to-bone contact and allows for more stable fixation. • In contrast, a protrusive BSSO often results in less bony overlap and a larger gap that may require additional grafting or bone substitutes to achieve stability. This can introduce variability in healing and stability. 2. Muscle and Soft Tissue Tension: • Retrusive movements generally place less tension on the surrounding soft tissues and musculature. Reduced tension helps in maintaining the stability of the new mandibular position post-surgery. • Protrusive movements can increase tension in the surrounding muscles and soft tissues, potentially leading to relapse due to the pull of the soft tissues trying to return to their original position. 3. Condyle Position: • Proper seating of the condyles in the glenoid fossa is crucial for postoperative stability. In retrusive BSSO, it is often easier to ensure that the condyles are seated correctly without additional pressure or displacement. • Protrusive movements may complicate the seating of the condyles, increasing the risk of condylar resorption or other temporomandibular joint issues. 4. Healing and Bone Remodeling: • The healing process after a retrusive BSSO tends to be more predictable and stable because the mandible is being compressed rather than distracted. Compressive forces are generally more favorable for bone healing. • Protrusive BSSO requires bone to fill in the gaps, which relies more on bone regeneration and can be less predictable, thus potentially reducing long-term stability. References: 1. Burke & Redford Orthodontists. (n.d.). Bilateral Sagittal Split Osteotomy. Retrieved July 2, 2024, from https://lnkd.in/e2w-brZ3 2. Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. (Eds.). (2012). Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.). Shelton, CT: PMPH-USA. 3. Proffit, W. R., White, R. P., & Sarver, D. M. (2013). Contemporary Treatment of Dentofacial Deformity. St. Louis, MO: Elsevier. 4. Reyneke, J. P. (2013). Essentials of Orthognathic Surgery (2nd ed.). Hanover Park, IL: Quintessence Publishing. 5. ChatGPT. 2024. - #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher