Oral Presentations

Wednesday, 13 September 2006, 14.3015.40

Orthognatic surgery: mandible III

Hall 8

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the risk of serious intraoperative and postoperative complications

in the tretment of mandibular prognathism.

Orthognatic surgery: mandible III

O.274 Change of condyle angulation after BSSO
M. Szalwinski1,2 , J. Piekarczyk1 , M. Jagielak1 , P. Piekarczyk1 .
1 2nd Department of MaxilloFacial Surgery, 2 Department of
Anatomy, Medical University of Warsaw, Poland
The aim of our study was to evaluate potential changes in
mandible condyle and ramus angulation after bilateral sagittal
split osteotomies.
The material contained 30 dry specimens of human mandibles
and their digital photographs before and after BSSO.
The method: Each mandible was photographed in three different
aspects from behind, laterally and from above. The position
of mandibles in front of camera objective was always constant,
and so was the distance for statistic recurrence. Using standard
surgical equipment sagittal osteotomies were performed due to
mandibular prognathism 15 cases and retrogenia 15 cases. Diameter between condyles was maintained. Digital photographs
were processed in DICOM. Using computer software followed
data were reported: angulation of mandible ramus to frontal,
transversal and sagittal plane, angulation of condyles to each
other.
Changes in the condyle angulation depending on the osteotomy
method were reported. No signicant role of osteotomy method
were reported. However, osteotomy plane may be signicant. Although results of our study performed in vitro, without occlusion
with maxilla could be disputable, we cannot deny inuence on
temporo-mandibular joint.

O.275 Modications in surgical treatment of

mandibular prognathism Own experiences
M. Baran, T. Tomaszewski, J. Wojciechowicz. Maxillofacial
Surgery, University Hospital, Lublin, Poland
Introduction: The most frequently utilized technique for surgical
treatment of mandibular deformities is bilateral sagittal split osteotomy (BSSO), originally described by Obwegeser and Trauner.
To this technique that is modied by Dal Pont and Hunsuck,
several changes were added in our Department. The changes aim
at limiting the soft tissues dissection, obtaining stable bone union
and elimination of possible complications: excessive bleeding,
unfavourable fractures, facial palsy.
Methods: The orthodontic decompensation and the third molars
previous removal are essential. The medial osteotomy is performed with 45 angulation to the medial plane of ramus. The
osteotomy does not cross the mandibular foramen, is led down
and forward across temporal crest, does not reach the oblique
ridge and in most cases ends half a way between them. To
straighten the osteotomy line, the connecting osteotomy passes
smoothly on both the medial and lateral osteotomy, performed at
the second molar level. The lateral osteotomy passes through both
the lateral and inferior cortex of the horizontal ramus reaching
lingual surface. The split is begun in the superior part, then in
retromolar area and is completed in lateral osteotomy area.
Results: Between years 1993 and 2006, described BSSO was
performed in 97 patients with excellent outcomes. Complications
such as relapse, facial palsy, dangerous hemorrhage or pseudoarthrosis, were not observed.
Conclusions: The modied osteotomy line and removal of the
third molars bring larger thickness of bone segments. The treatment results show that the proposed BSSO modications decrease

O.276 Endoscopic-assisted rigid xation in intra-oral

vertical subsigmoid osteotomy: A preliminary
study
L.O. John, L.K. Cheung. Oral & Maxillofacial Surgery, Faculty
of Dentistry, The University of Hong Kong, China
Introduction: Intra-oral vertical subsigmoid osteotomy (IVSO)
is a mandibular ramus osteotomy technique used to correct
mandibular prognathism. It is an easily learned surgical procedure executed transorally, and results in fewer neurosensory
disturbances than sagittal split osteotomy. However, the intra-oral
route limits visibility and makes access to the application of rigid
xation difcult. Post-operative intermaxillary xation (IMF) for
several weeks is mandatory to ensure stability for bone healing.
Objectives: (1) To illustrate the clinical technique of endoscopeassisted rigid xation in intra-oral vertical subsigmoid osteotomy
(VSO); and (2) to report on early post-operative morbidities.
Material and Methods: Six patients presenting with Class 3
skeletal prole were recruited. The osteotomy was performed
through an intra-oral route. Rigid xation was achieved with a
3 mm stab incision located inferior to the ear pinna allowing
access to the transbuccal trocar. A rigid endoscope was introduced intra-orally to improve visibility during xation. Patients
preoperative and 3-month post-operative radiographs and clinical morbidities (neurosensory status & temporomandibular joint
(TMJ) function) were assessed.
Results: 83.3% of patients fully recovered inferior alveolar nerve
function, and 66.6% recovered TMJ function. The scar from the
stab incision was effectively camouaged by the ear pinna, and
was not noticeable by the patients.
Conclusion: This preliminary study conrms that the application
of endoscope-assisted rigid xation in intra-oral VSO is clinically feasible. All the patients presented with minimal clinical
morbidities and good stability at the early post-operative period.
O.277 Facial palsy after mandibular bilateral split
osteotomy Analysis of a rare and seldom
complication
E.-L. Barth, N.-C. Gellrich, P. Brachvogel. Department for
Cranio-Maxillofacial Surgery, Hannover Medical School,
Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Introduction and Objectives: Since Obwegeser introduced his
operation technique in the 1950s, it had become, with slight
modications (DAL PONT, EPKER, HUNSUCK), the most
used surgical procedure to treat mandibular growth anomalies.
Although it is a highly standard procedure with calculable risks,
the literature shows many reports about facial nerve palsies as a
rare and seldom complication.
Material, Methods and Results: In a retrospective survey
over 23 years (19832006) we followed up 1826 patients who
underwent orthognathic surgery in our department. In 9 patients
a facial palsy occurred post-operatively (0.49%) In 8 cases it was
transient, in 1 case a permanent facial nerve paralysis. The aim
of the study was to analyse the dependent factors which led to
the nerve injury and how it is possible to prevent such a serious
complication.
Conclusions: However orthognathic surgery is a kind of elective
surgery in healthy people, the appearance of a postoperative
facial palsy is nearly the worst case for both sides, patient and
surgeon, because quality of life, especially social interaction, is
signicantly reduced.