Sagital Split Osteotomy
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Sagital Split Osteotomy

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Surgical Procedure:

Steps 5 to 9

5. Bone splitting (fig:5)
   Bone splitting is started at the anterior aspect of the medial cut on the vertical ramus using a 4 mm. osteotome.The same osteotome is used down the whole length of the bony cuts in different areas. A larger osteotome is used to repeat the cuts.
   Spreader (Smith bone spreader) is engaged in the split and the split is spread out to completion. Care should be taken not to cut the inferior alveolar nerve.

Steps 1 to 5 are repeated on the opposite side.

6. Mandibular Repositioning (fig:6)
   Mandibular setback is achieved and the prefabricated splint is placed in proper occlusion and intermaxillary fixation is done.

Once both sides are split further procedure varies depending on the purpose of the surgery. Mandibular setback is done for mandibular prognathism, mandibular advancement is done for retruded mandible and mandibular repositioning is done for facial asymmetry.

7. Excess Bone Removal (fig:7)
  The position of the proximal segment is assessed. Make sure that the condyles are in a passive position in the glenoid fossa. The pre-op analysis and measurements made are marked on the buccal plate of the proximal segment which juts out anteriorly and the excess is cut off and removed.
8. Rigid Fixation (fig:8)
  The proximal segments are approximated and the split is closed.A mini bone plate is used to rigidly fix the mesial and distal segments. Usually a 2.5mm 4-hole with gap mini plates and 2.5 x 6mm screws are used.

The steps 7 & 8 are repeated on the opposite side and the IMF removed.

9. Wound Closure (fig:9)
  Haemostasis is achieved and the wound is closed using 3'O' vicryl suture (individual preference). Infiltrate the local area with sensocaine 0.5% for pain relief and homeostasis. Pressure dressing with dynaplast is given extraorally to control swelling and hematoma formation. After reversal of anesthesia, maintain a lateral position to prevent aspiration of any discharge and closely monitored in the ICU for 24 hours.

Postsurgical Orthodontia can be commenced after 3 - 4 weeks. A good teamwork is necessary between the Orthodontist and the Maxillofacial Surgeon. ClassIII, box or cross elastics maybe used to achieve maximum intercuspation. Evidence of skeletal relapse should be closely monitored and remedial measures are to be taken if any relapse is observed. A chin-cap maybe used at night to prevent relapse.

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Prof. (Dr) Varghese Mani, Oral and Maxillofacial Surgeon
Member Dental Council of India
Past President Oral and Maxillofacial Surgeons of India.
Consultant
Mani Specialty Clinic, MG Road, Trichur, Kerala 680004, India. Phone -- 0091-0487-385996
Trichur Institute of Head and Neck Surgery (TIHANS), Shornur Road, Trichur.

Email Dr Varghese Mani


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updated Aug2002.