CBCT location of the fusion between the buccal and lingual cortical 
in the mandibular ramus: importance to sagittal split osteotomy

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Abstract

Background

Mandibular Sagittal Split Osteotomy (MSSO) is a popular technique in orthognathic surgery used both to advance and to retreat the mandible. However, MSSO may incur in important complications, such as bad splits and sensorineural injuries. Knowing the location of the fusion between the buccal and lingual cortical (FBLC) in the mandibular ramus and the bone thickness in the region where osteotomies will be performed is determinant in MSSO planning to avoid complications. The aim of this study was to document and evaluate possible differences between sexes regarding the location of the FBLC in relation to the superior cortical of mandibular foramen (MF) and bone thickness in the region of interest for MSSO in a Brazilian population.

Material and Methods

Eighty five cone-beam Computed Tomography (CBCT) scans were used to perform linear measurements to determine the location of the FBLC. Bone thickness from the mandibular canal (MC) to the cortical external surfaces and the diameter of the MC were measured at three different points: mandibular ramus (A), mandibular angle (B) and mesial of the second molar (C).

Results

The FBLC was located at a mean distance of 8.3 mm from the superior cortical of the MF in males and 8.1 mm in females. There was no difference between males and females regarding the mean bone thickness from the MC to the buccal external surface at all the points investigated ( p >>0.05). Bone thickness from the lingual external surface to the MC was bigger among females than males in regions B and C ( p<0.05). The diameter of the MC was bigger among males in regions B and C.

Conclusions

Sexual dimorphism regarding mandibular bone thickness but not regarding the location of FBLC was present. This fundamental knowledge may assist to the panning of MSSO.

Key words:Cone-Beam Computed Tomography, mandibular nerve, orthognathic surgery, sagittal split ramus osteotomy.

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Most cited references 29

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Incidence of complications and problems related to orthognathic surgery: a review of 655 patients.

K Panula, K Finne, K Oikarinen (2001)

This retrospective report evaluates the incidence of pre-, intra-, and postoperative complications of orthognathic surgery and their significance to the patient. The clinical records and radiographs of 655 patients operated on in Vaasa Central Hospital, Finland during a 13-year period between 1983 and 1996 were examined. The total number of operations was 689. All notes referring to problems or complications from the orthodontic phase to the varying postoperative follow-up times were gathered and analyzed. The most common complication was a neurosensory deficit in the region innervated by the inferior alveolar nerve; mild in 32% of patients (183 of 574 patients with an osteotomy in the mandible) and disturbing in 3% of patients (18/574). The most serious complication was severe intraoperative bleeding in 1 patient necessitating major blood transfusions and later embolization of the internal maxillary artery. There were no fatal complications. The incidence of other problems was low, and there were very few patient complaints. Despite the great variety of severe complications reported in the literature, their frequency seems to be extremely low, and orthognathic surgery treatment can be considered to be a safe procedure. Copyright 2001 American Association of Oral and Maxillofacial Surgeons

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Sensory testing of inferior alveolar nerve injuries: a review of methods used in prospective studies.

Lucas Poort, Johan van Neck, Karel G.H. van der Wal (2009)

The inferior alveolar nerve (IAN) can be injured during trauma or surgery. So far there is no consensus for evaluating IAN injury. This study aimed to identify a testing method suitable for daily clinical practice which allows us to identify nerve injury, grade its severity, and monitor its recovery. Covering a 20-year period, prospective studies on sensory changes after mandibular procedures were reviewed regarding sensory testing methods; 75 studies on third molar removal, osteotomy, fracture, and implants were included. These studies reported varying incidences. In third molar removal and implant studies, a limited number of sensory tests were used, whereas in osteotomy and fracture studies more detailed testing was performed, using reproducible tests like light touch test with Semmes-Weinstein monofilaments and 2-point discrimination. Sensory function was not uniformly tested and presented, making a comparison of data impossible and highlighting the need for uniform testing methodology. Based on the results of this review, the light touch test with Semmes-Weinstein monofilaments for grading is recommended, using a grid and control site describing unilateral or bilateral nerve injury. Additionally, a visual analog scale-based questionnaire should be used to evaluate subjective sensibility. Using this method to test IAN injuries will allow comparison of future studies and provide valuable insight in the severity and prognosis of IAN injuries.

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Neurovascular anatomical variations in the anterior palate observed on CBCT images.

Christiano de Oliveira-Santos, Izabel R F Rubira-Bullen, Solange A C Monteiro … (2013)

This study aimed to assess the presence of additional foramina and canals in the anterior palate region, through cone beam computed tomography (CBCT) images, describing their location, direction, and diameter.

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Author and article information

Journal

Journal ID (nlm-ta): Med Oral Patol Oral Cir Bucal

Journal ID (iso-abbrev): Med Oral Patol Oral Cir Bucal

Journal ID (publisher-id): Medicina Oral S.L.

Title: Medicina Oral, Patología Oral y Cirugía Bucal

Publisher: Medicina Oral S.L.

ISSN (Print): 1698-4447

ISSN (Electronic): 1698-6946

Publication date (Print): July 2017

Publication date (Electronic): 18 June 2017

Volume: 22

Issue: 4

Pages: e500-e505

Affiliations

[1 ]Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo - Brazil

Author notes

Faculdade de Odontologia de Bauru Alameda Otavio Pinheiro Brisolla 9-75 Bauru- SP CEP 17012-901 , E-mail: izrubira@ 123456fob.usp.br

Conflict of interest statement:We declare no conflict of interest.

Article

Publisher ID: 21632

DOI: 10.4317/medoral.21632

PMC ID: 5549524

PubMed ID: 28624835

SO-VID: 7f8bb545-4e1d-4a43-a470-8b67e3418eca

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

CBCT location of the fusion between the buccal and lingual cortical in the mandibular ramus: importance to sagittal split osteotomy

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Abstract

Background

Material and Methods

Results

Conclusions

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ScienceOpen Clinical Case Reports Collection

Most cited references 29

Incidence of complications and problems related to orthognathic surgery: a review of 655 patients.

Sensory testing of inferior alveolar nerve injuries: a review of methods used in prospective studies.

Neurovascular anatomical variations in the anterior palate observed on CBCT images.

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