Fixation Methods Used in Sagittal Split Ramus Osteotomy

Year 2024, Volume: 3 Issue: 1, 43 - 51, 15.01.2024

Özgün Mehmet İnan , İnci Karaca , Doğan Dolanmaz

Abstract

The sagittal split ramus osteotomy (SSRO) is a technique frequently used in orthognathic surgery for the treatment of congenital
or acquired mandibular irregularities. Congenital or acquired deformities of the mandible, such as hypoplasia, hyperplasia, and
asymmetry, can be corrected with this method. The SSRO procedure creates a broad bone contact surface in the mandible,
supporting both post-operative stability and the early healing process. Additionally, this technique prepares a suitable foundation
for the application of various fixation methods. The correct fixation of the segments after osteotomy directly affects the success
of the procedure. Ensuring immobility between the bone fragments is of critical importance to the success of the surgery. Among
the fixation materials and techniques used after SSRO are wire osteosynthesis, intermaxillary fixation, bicortical screw systems,
mini plate-screw systems, hybrid systems using bicortical screws and plates, and resorbable mini plate-screw systems. An
ideal fixation system should promote rapid bone healing, the commencement of early mandibular function post-operatively, and
a reduction in the amount of relapse. However, despite many studies on this topic, an universally accepted ideal fixation method
has yet to be determined. In our review, various fixation types and methods used for the frequently applied SSRO method in
orthognathic surgery have been examined in detail. Information on the advantages, disadvantages, and effectiveness in clinical
application of these techniques has been provided. The selection of the correct fixation method, which plays a critical role in the
success of SSRO, is believed to directly impact both patient outcomes and the healing process. In this context, our review aims to
provide clinicians with information and guidance in determining the most suitable fixation method for potential clinical scenarios
they may encounter.

Keywords

fixation, stabilization, sagittal split ramus osteotomy

References

• 1. Miloro M, Peterson LJ. Peterson’s principles of oral and maxillofacial surgery. 3rd ed. Shelton, CT: People’s Medical Pub. House-USA; 2012. p.1187-1493.
• 2. Malik NA. Textbook of oral and maxillofacial surgery: JP Medical Ltd; 2012. p.259-285
• 3. Fonseca. Oral and maxillofacial surgery. In: Fonseca RJ, editor. Elsevier. 3 ed. St. Louis, Missouri : Elsevier, [2018]2014. p. 1-325.
• 4. Toller MÖ. ÇENE CERRAHLARI İÇİN ORTOGNATİK CERRAHİ. 1. Ankara: Özyurt Matbaacılık; 2009. p. 103 - 37.
• 5. Sato FR, Asprino L, Consani S, de Moraes M. Comparative biomechanical and photoelastic evaluation of different fixation techniques of sagittal split ramus osteotomy in mandibular advancement. J Oral Maxillofac Surg. 2010;68(1):160-6.
• 6. Wyatt WM. Sagittal ramus split osteotomy: literature review and suggested modification of technique. Br J Oral Maxillofac Surg. 1997;35(2):137-41.
• 7. Wolford LM. The sagittal split ramus osteotomy as the preferred treatment for mandibular prognathism. Journal of oral and maxillofacial surgery. 2000;58(3):310-2.
• 8. Cho HJ. Long-term stability of surgical mandibular setback. The Angle Orthodontist. 2007;77(5):851-6.
• 9. Joss CU, Vassalli IM. Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. Journal of oral and maxillofacial surgery. 2009;67(2):301-13.
• 10. Bonanthaya K, Panneerselvam E, Manuel S, Kumar VV, Rai A. Oral and Maxillofacial Surgery for the Clinician: Springer; 2021. p.1437-1577
• 11. Watzke IM, Turvey TA, Phillips C, Proffit WR. Stability of mandibular advancement after sagittal osteotomy with screw or wire fixation: a comparative study. Journal of oral and maxillofacial surgery. 1990;48(2):108-21.
• 12. Hoffman GR, Moloney FB. The stability of facial osteotomies. 2. Mandibular advancement with bicortical screw fixation. Australian Dental Journal. 1995;40(4):213-9.
• 13. Olivera LB, Sant’ Ana E, Manzato AJ, Guerra FL, Arnett GW. Biomechanical in vitro evaluation of three stable internal fixation techniques used in sagittal osteotomy of the mandibular ramus: a study in sheep mandibles. J Appl Oral Sci. 2012;20(4):419-26.
• 14. Assael LA. Manual of Internal Fixation in the Cranio-Facial Skeleton.: Techniques as recommended by the AO/ASIFMaxillofacial Group: Springer Science & Business Media; 1998.
• 15. Erdoğan Ö, Sanrı M, Kahraman OE. Ağız, çene, yüz cerrahisinde çekme vidalarının kullanımı üzerine literatür derlemesi. Gazi Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2011;28(3):225-32.
• 16. Van Sickels JE, Richardson D. Stability of orthognathic surgery: a review of rigid fixation. British Journal of Oral and Maxillofacial Surgery. 1996;34(4):279-85.
• 17. Franz Haerle MC, Bill C.Terry. Atlas of Craniomaxillofacial Osteosynthesis. 2 ed. New York: Thieme Medical Publishers, Inc; 2009. p.1-145.
• 18. Michelet FX, Deymes J, Dessus B. Osteosynthesis with miniaturized screwed plates in maxillo-facial surgery. Journal of maxillofacial surgery. 1973;1:79-84.
• 19. Schwartz HC, Relle RJ. Bicortical-monocortical fixation of the sagittal mandibular osteotomy. J Oral Maxillofac Surg. 1996;54(2):234-5.
• 20. Cilasun U, Uckan S, Dolanmaz D, Saglam H. Immediate mechanical stability of sagittal split ramus osteotomy fixed with resorbable compared with titanium bicortical screws in mandibles of sheep. Br J Oral Maxillofac Surg. 2006;44(6):534-7.
• 21. Edwards RC, Kiely KD, Eppley BL. Fixation of bimaxillary osteotomies with resorbable plates and screws: experience in 20 consecutive cases. Journal of oral and maxillofacial surgery. 2001;59(3):271-6.
• 22. Tulasne JF, Schendel S. Transoral placement of rigid fixation following sagittal ramus split osteotomy. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 1989;47 6:651-2.
• 23. Dolce C, Hatch JP, Van Sickels JE, Rugh JD. Rigid versus wire fixation for mandibular advancement: skeletal and dental changes after 5 years. Am J Orthod Dentofacial Orthop. 2002;121(6):610-9.
• 24. Maurer P, Knoll W-D, Schubert J. Comparative evaluation of two osteosynthesis methods on stability following sagittal split ramus osteotomy. Journal of Cranio- Maxillofacial Surgery. 2003;31(5):284-9.
• 25. Pereira Filho VA, Iamashita H, Monnazzi M, Gabrielli MFR, Vaz LG, Passeri L. In vitro biomechanical evaluation of sagittal split osteotomy fixation with a specifically designed miniplate. International Journal of Oral and Maxillofacial Surgery. 2013;42(3):316-20.
• 26. Sindel A, Demiralp S, Colok G. Evaluation of different screw fixation techniques and screw diameters in sagittal split ramus osteotomy: finite element analysis method. Journal of oral rehabilitation. 2014;41(9):683-91.
• 27. Borstlap W, Stoelinga P, Hoppenreijs T, Van’t Hof M. Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with twoyear follow-up: Part I. Clinical parameters. International journal of oral and maxillofacial surgery. 2004;33(5):433- 41.
• 28. Oguz Y, Watanabe ER, Reis JM, Spin-Neto R, Gabrielli MA, Pereira-Filho VA. In vitro biomechanical comparison of six different fixation methods following 5-mm sagittal split advancement osteotomies. Int J Oral Maxillofac Surg. 2015;44(8):984-8.
• 29. Cilasun U, Uckan S, Dolanmaz D, Saglam H. Immediate mechanical stability of sagittal split ramus osteotomy fixed with resorbable compared with titanium bicortical screws in mandibles of sheep. British Journal of Oral and Maxillofacial Surgery. 2006;44(6):534-7.
• 30. Ueki K, Marukawa K, Shimada M, Nakagawa K, Yamamoto E. Change in condylar long axis and skeletal stability following sagittal split ramus osteotomy and intraoral vertical ramus osteotomy for mandibular prognathia. Journal of oral and maxillofacial surgery. 2005;63(10):1494-9.