A study of mandibular ramus anatomy and its significance to sagittal split osteotomy

Tom, William K.; Martone, Christopher H.; Mintz, Sheldon

doi:10.1016/s0901-5027(97)80814-4

Cited by 28 publications

(27 citation statements)

References 6 publications

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“…The presence and positioning of mandibular third molars, surgeon inexperience, osteotomy design and mandibular morphology have been pointed as risk factors related to bad splits ( 4 ). There is a great concern in the literature about the fusion of the buccal and lingual mandibular cortical above the mandibular foramen (MF), since bad splits supposedly occur when an osteotomy is performed above or just at this point, at which there is no medullary bone ( 11 - 13 ). Previous investigations have suggested that lesions on the IAN are also more likely to occur in patients who present a thin medullary bone between the mandibular canal (MC) and the external mandibular cortical ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

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

Scomparin¹,

Soares²,

Rubira³

et al. 2017

Med Oral

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BackgroundMandibular 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 MethodsEighty 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).ResultsThe 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.ConclusionsSexual 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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Section: Introductionmentioning

confidence: 99%

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

Scomparin¹,

Soares²,

Rubira³

et al. 2017

Med Oral

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“…17 The results showed 64.8% of the fracture lines as proposed by Hunsuck and Epker,22.2% running to the posterior border of the ramus, and 13% through the mandibular canal. No unintentional or bad split was observed.…”

Section: Discussionmentioning

confidence: 83%

“…20,21 A survey reported in 1997 examined the anatomy of the ramus focusing on the fusion of the lingual and buccal cortical bone and highlighted that an osteotomy more than 5 mm above the lingula increases the chance of a cut ending in an area of buccal and lingual cortical fusion. 22 Analyzing CT scans, another study showed that there is a high rate of class III patients who have a thinner anterior ramus and either a separation of cancellous bone at the level of the lingula or an absence of cancellous bone posterior to the lingula. 23 The authors considered that the extension of the osteotomy into an area with both less buccolingual thickness and less cancellous bone increases the rate of bad splits.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional fracture pattern analysis of the Obwegeser and Dal Pont bilateral sagittal split osteotomy

Dreiseidler

Bergmann

Zirk

et al. 2016

International Journal of Oral and Maxillofacial Surgery

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“…Lingula has been an important landmark to perform the sagittal split ramus osteotomy (SSRO), the most widely used surgical technique for correction of mandible positioning. On SSRO, the horizontal cut on the medial aspect of the mandible is done just above to the lingual (Cillo & Stella;Tom et al, 1997).…”

Section: Introductionmentioning

confidence: 99%

Mandibular Foramen Location and Lingula Height in Dentate Dry Mandibles, and its Relationship With Cephalic Index

et al. 2015

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SUMMARY:The mandibular foramen and its lingula is a major landmark when administering anesthetic or performing surgical procedures. The objective of this study was to determine whether the topological features of the mandibular foramen (MF) and lingula varied in mandibles from skulls of different cephalic indexes. The location of the mandibular foramen referred to the longitudinal borders of the mandibular ramus (MR), height of the foramen (Hf) referred to the occlusal line of the second molar, and the height of the lingula (Hl) were determined in a total of one hundred and five dry mandibles from skulls identified as dolicho-meso-and brachycephalic. On average MF in brachycephalic mandibles was closest to the anterior border of MR. Hf in brachy-, meso-and dolichocephalic mandibles were -0.22 mm, -4.04 mm and -4,01mm, respectively. The lingula in brachycephalic specimens was considerably shorter (0.78 mm) than in dolichocephalic ones (1.84 mm). Inferior alveolar nerve block should be carried out using shorter needles, inserting it 4mm above the occlusion level of the molar teeth. The ramus of brachicephalic mandibles were significantly less wide those of dolicho-and mesocephalic ones. If the height of the lingula is to be used as a reference to judge the level of the medial horizontal cut to carry out sagittal split ramus osteotomy, special attention should be given to the patient's cephalic index.

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A study of mandibular ramus anatomy and its significance to sagittal split osteotomy

Cited by 28 publications

References 6 publications

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

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

Three-dimensional fracture pattern analysis of the Obwegeser and Dal Pont bilateral sagittal split osteotomy

Mandibular Foramen Location and Lingula Height in Dentate Dry Mandibles, and its Relationship With Cephalic Index

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