“The Use Of Bone Grafts Or Modified BSSO Technique In Large Mandibular Advancements Reduces The Risk Of Persisting Mandibular Inferior Border Defects”

Publication date: Available online 11 September 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Julio Cifuentes, Nicolás Yanine, Daniel Jerez, Ariel Barrera, Jimoh Olubanwo Agbaje, Constantinus Politis
PurposeHealing of the inferior border of the mandible may be compromised in large advancements, leaving an unaesthetic defect at the inferior border. The objective of this article is to compare different bilateral sagittal split osteotomy (BSSO) techniques in order to prevent the incidence of lower border mandibular defects.Patients and MethodsThe authors undertook a retrospective multicenter cohort study comparing three BSSO techniques for advancements greater than 5 millimeters: Traditional Non-Grafted BSSO Technique (group A), Traditional Grafted BSSO Technique (group B) and Modified BSSO Technique (group C). The space created by the mandibular advancement was measured. The presence or absence of a defect was determined one year post-surgery by clinical and radiographic assessment. The bone defect outcome was associated with potential risk predictors (age, sex, side of sagittal split osteotomy, and magnitude of mandibular advancement) by logistic regression analysis.ResultsA total of 1002 operative sites in 501 patients were included in the study. Age 26,8 SD (11), sex (310 female, 191 male) and mandibular advancement (9,3mm right side, 10mm left side) were similar between the groups. (p>.05) The proportion of post-surgical lower border mandibular defects were: group A 54,5%, group B 1,3% and group C 10,6%. The Traditional Grafted BSSO Technique, and Modified BSSO Technique were significantly more effective in preventing the incidence of mandibular lower border defects compared with Traditional Non-Grafted BSSO Technique. (p<.05)ConclusionSurgeons are advised that there is a significant proportion of mandibular lower border defects with the Traditional Non-Grafted BSSO Technique.The use of bone grafts or the modified BSSO technique in mandibular advancements greater than 10 mm significantly reduces the risk of persisting mandibular inferior border defects.



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