What Is a Sagittal Split Osteotomy?

Sagittal split osteotomy of the ascending branch of the mandible is suitable for the common operations of dental maxillofacial deformities such as mandibular protrusion, open deformity, small jaw deformity, partial jaw deformity, and first branchial arch syndrome.

Mandibular ascending sagittal osteotomy

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Sagittal split osteotomy of the ascending branch of the mandible is suitable for the common operations of dental maxillofacial deformities such as mandibular protrusion, open deformity, small jaw deformity, partial jaw deformity, and first branchial arch syndrome.

Chinese name

Mandibular ascending sagittal osteotomy

Foreign name

Sagittal split ramus osteotomy operation

Mandibular ascending sagittal osteotomy

Sagittal split osteotomy of the ascending branch of the mandible; sagittal split osteotomy of the ascending branch of the mandible; sagittal split ramus osteotomy;

Stomatology / Orthognathic surgery / Surgery correction of mandibular deformity / Mandibular ascending osteotomy

76.6401

Mandibular ascending sagittal split osteotomy is used to correct the mandibular deformity. Mandible and blood supply.

Sagittal split osteotomy of the ascending branch of the mandible is suitable for the common operations of dental maxillofacial deformities such as mandibular protrusion, open deformity, small jaw deformity, partial jaw deformity, and first branchial arch syndrome.

1. X-ray head positioning film was used to measure the relationship between the mandible and skull base plane, orbital ear plane and plane, determine the ascending branch osteotomy method, moving distance and direction, and perform paper cutting to predict the degree of postoperative deformity correction.

2. Model surgery transfers the joint and intraoral occlusal relationship to Han's frame. Saw open the research model to rearrange the occlusal relationship of the maxillary teeth, and observe the moving distance of the osteotomy block in the three-dimensional space.

3. Plate production, based on model surgery, the plate is made of self-setting plastic.

4. On the basis of fixing the appliance before surgery, the arch wire is bent into a hooked splint capable of intermaxillary traction and ligated and fixed. Or make bands on the canines and second molars on both sides of the upper and lower jaws, place the splints with hooks and ligate the splints on each tooth separately for inter-maxillary fixation including the plate during and after surgery .

The operation was performed under general anesthesia with a nasal cannula.

The patient takes a supine position, shoulder pads, and his head slightly back.

1. Do not damage the lower alveolar vascular bundle when the periosteum is peeled off the medial ascending branch. In the supine position, the bone inside the leading edge of the ascending branch is thick and obstructs the visual field. Pay special attention to the peeling of the periosteum at the posterior edge of the medial side. It can only be determined by placing the hook properly.

2. The horizontal osteotomy line inside the ascending branch during osteotomy. The medial bone plate is cut transversely from front to back. Do not damage the wing and jaw space and important nerves and blood vessels in the posterior fossa when electric drill and saw osteotomy. During longitudinal splitting, the osteotome should be close to the lateral bone plate of the ascending branch. Do not damage the nerves and blood vessels in the mandibular canal. Split the depth to reach the posterior edge of the ascending branch and the lower edge of the mandible.

3. The bone removal depends on the purpose of the sagittal osteotomy of the ascending branch, and the location of the bone removal is different. For example, when the osteotomy is retracted, the lateral bone fragments are removed before and below the bone; when the osteotomy is retracted and raised, the upper edge of the medial bone fragments need to be deboned; when the osteotomy is extended, the front of the medial bone fragments need to be deboned.

4. Postoperative hemostasis and complete ascending sagittal osteotomy should be performed stably and accurately. The use of bone knife and hammer should be focused and rhythmic, to avoid rough force, and to avoid accidental damage to the inferior alveolar artery and posterior jaw in the wing and jaw space. The fossa's external carotid artery, facial nerve, and external maxillary artery in the submandibular area. When the bone is fixed, the inner and outer bone pieces should be tightly pressed and fixed to prevent bleeding from the bone marrow cavity of the osteotomy surface.

After sagittal split osteotomy of the ascending branch of the mandible, do the following:

After orthognathic surgery, those who use general anesthesia should be sent to the anesthesia recovery room or Intensive Care Unit (ICU) for close observation and routine nursing after general anesthesia. Special attention should be paid to protecting the patency of the respiratory tract and the presence of significant bleeding. Those who have made intermaxillary fixation should be more vigilant to prevent the possibility of respiratory obstruction. For patients who may or are prone to airway obstruction, catheters of good material quality can be used, and the method of retaining catheters after surgery is used to ensure that patients safely pass the peak period of postoperative tissue edema and avoid the occurrence of airway obstruction.

After the whole body is stable, the first problem is to maintain the fixation of the bone segment to ensure that the bone mass heals smoothly in the ideal position. For intermaxillary fixation or extraoral stent fixation, frequent inspection and observation are needed, and adjustment or reinforcement is necessary. These external fixations generally need to be maintained for about 2 months, but depending on the surgical site (maxillary or mandibular), the size of the scope (full or partial osteotomy), whether interosseous fixation has been performed, etc. The time limit is adjusted. At present, the fixation of bone mass is often performed by titanium bone plate. Reduced time between fixations.

Because orthognathic surgery often has intraoral wounds and is often used for intermaxillary fixation, maintaining oral hygiene is important. In the early postoperative period, medical staff usually assist in cleaning the oral cavity; in the later period, the patient can gargle or clean it with a small toothbrush. In oral care, care should be taken to avoid disturbing the wound or causing the ligature to loosen or shift.

Preventing recurrence and maintaining the curative effect are important tasks in the postoperative period. The measures should be started mainly during surgery, including: suitable and reliable fixation methods, the mandibular condyle must be kept in the joint socket to fix the bone segment, and necessary auxiliary surgery (such as excessive tongue resection) Wait. Postoperative management is also important, including maintaining fixation, wearing a position retainer, and correcting bad habits (such as tongue extension).

After orthognathic surgery, most patients still need postoperative orthodontic supervision and management. Its contents include: helping to prevent recurrence, adjusting the occlusion, closing the gap, etc. to achieve the ideal occlusal relationship, maintaining a satisfactory chewing function and appearance. When the patient is discharged, the patient should be told to return to the clinic about once every two weeks in order to guide and change the intermaxillary traction, appliance, etc. according to his age, type of deformity, surgical method, etc., and choose an appropriate time to remove the plate, etc. To ensure good surgical results.

Complications may occur during and after orthognathic surgery. The surgeon should perform the operation in a serious and responsible spirit, follow the requirements of the operation, operate correctly and carefully, observe the condition closely after the operation, and handle the abnormal situation in time to prevent various complications.

1. Sagittal split osteotomy for ascending branch of mandible 1. Respiratory obstruction

Acute obstruction of the respiratory tract, or even suffocation, is the most serious complication. During general anesthesia recovery, respiratory tract obstruction may be caused by vomiting aspiration, secretion obstruction, improper posture, fall of tongue, edema of throat after tracheal intubation and extubation, and subsequent local tissue edema, and intermaxillary fixation. Measures should be taken to prevent it from happening. And closely observe the condition to eliminate the factors that may cause acute obstruction of the respiratory tract. If symptoms of dyspnea appear (such as nasal wing sedition, three concave signs, etc.), they should be handled in time to prevent the occurrence of asphyxia complications.

2. Mandibular ascending branch sagittal split osteotomy 2. bleeding

Intraoperative injury of large blood vessels can cause severe bleeding, such as damage to the maxillary artery or iliac artery during LeFort type osteotomy, and damage to the alveolar artery during ascending osteotomy of the mandible. Therefore, during the LeFort osteotomy, the osteotome cannot be placed too high during the disconnection of the maxillary back from the wing plate, and the direction of the gouge cannot be upward to prevent damage to the internal maxillary artery. When truncating the medial wall of the maxillary sinus, care should be taken to avoid damage to the iliac aorta near the back end. A osteotome can often be used to avoid osteotomy and not to reach the posterior edge, but to retain part of the bone to prevent accidental injury to the aorta. After the maxilla has been broken downwards with techniques and instruments, the posterior bone is repaired. For sagittal split osteotomy of the ascending branch of the lower jaw, the osteotome should not be cut too deep to avoid damage to the inferior alveolar artery. After the ascending branch is split by the "split" method, the bone slice is opened. Directly re-dress the bone. When performing mandibular ascending branch longitudinal osteotomy (vertical or oblique osteotomy), the osteotomy line should be kept behind the mandibular foramen to prevent damage to the inferior alveolar artery.

3. Sagittal split osteotomy for ascending branch of mandible 3. Nerve injury

For example, the sagittal split osteotomy of the ascending branch of the lower jaw may injure the alveolar nerve by mistake. The precautions for osteotomy are the same as for preventing damage to the alveolar artery. When completing the osteotomy and moving the bone segment for fixation, care should be taken to avoid the occurrence of postoperative nerve injury symptoms caused by the inferior alveolar nerve being compressed by the bone segment.

4. Sagittal split osteotomy for ascending branch of mandible 4. Bone segment necrosis

The reasons are mostly caused by excessive stripping of soft tissue or damage to the supply vessels. Therefore, the range of separation and exposure of the bone surface should not be too large, especially the soft tissue on the surface of the telecentric bone segment (bone segment near the gum). The soft tissue on the surface should not be separated too much, but it should be kept as close as possible to maintain blood circulation and ensure bone. Quality healing.

5. Sagittal split osteotomy for ascending branch of mandible 5. Injury of root tip and pulp necrosis

The root is cut off at the same time because the horizontal osteotomy line is too low (too close to the incisor or face of the tooth). Therefore, the possible position of the root apex should be judged. The method includes: taking a dental X-ray film to detect the position and length of a tooth root, referring to data of a normal normal root length, and observing a slight bulge of the alveolar bone wrapped around the tooth during the operation. After estimating the length of the root and the location of the apex of the tooth, design a transverse osteotomy line 4 to 5 mm in the telecentric direction of the apex of the tooth (the upper jaw is above the upper tooth apex and the lower jaw is below the lower tooth apex).

6. Mandibular ascending branch sagittal split osteotomy 6. No bone connection or poor bone healing

It is mainly caused by poor fixation, insufficient contact of the bone section, and poor blood circulation supply. Therefore, the bone must be well fixed during and after the operation. Generally, interosseous fixation (ligation or micro-plate strong internal fixation) is often used, and supplemented by intermaxillary fixation, suspension fixation, external mouth bracket fixation, etc. In addition, the design of osteotomy should consider as much as possible to contact the wound surface when the bone segment (block) is connected, and to prevent excessive peeling of the soft tissue and the like during the operation.