Mandibular body ostectomy for correction of mandibular prognathism – A technical note

Abstract

The patient presented with a large mandibular body and acceptable occlusion in the molar region with no lateral crossbite. After presurgical orthodontic treatment, mandibular body ostectomy was performed in the missing second premolar region. To avoid nerve injury, we considered removal of the lateral cortical plate around the mental foramen and temporary wire fixation of the detached bone segments during contralateral body ostectomy. Neurosensory supply of the mental region recovered within 3 months after surgery. Three years after surgery, the occlusion and periodontal health were good.

Combination approach for treatment of mandibular prognathism: Bilateral saggital split osteotomy with pre & post surgical orthodontics

“…As shown in oue case, if the mental neurovascular bundle is present in osteotomy site then there is a higher risk of inferior alveolar nerve injury. 8,9 It also carries a risk of damage to the roots and periodontal health of teeth involved in osteotomy site, which might require postsurgical endodontic and periodontal treatment of involved teeth. There is also a deficit of sufficient bony contact area for fixation and osteogenesis.…”

“…There is also a deficit of sufficient bony contact area for fixation and osteogenesis. [9][10][11] Complications of inferior alveolar nerve injury can be drastically reduced by creating a bony window to enclose the inferior alveolar neurovascular bundle, by surgical repositioning or by creating enough room for osteotomy in presurgical orthodontic treatment, which also reduces the incidence of root damage and invasion of periodontal spaces of involved teeth. 4,9 We kept the osteotomy lines away from the mental foramen to avoid injury to mental neurovascular bundle.No neurosensory disturbance was noticed after a week of surgery.…”

Mandibular Body Osteotomy for Skeletal Class Iii Malocclusion: A Case-Based Review

“…The disadvantages of body osteotomy is that it carries a higher risk of inferior alveolar nerve injury as the mental neurovascular bundle is present in the path of osteotomy. 2,11 There is a higher risk of damage to the roots and unpredictable periodontal healing of adjacent teeth as the osteotomy is in the dentate area which might require post-operative endodontic and periodontal management of the adjacent teeth. There is also a lack of adequate bony contact area for fixation and osteogenesis.…”

“…There is also a lack of adequate bony contact area for fixation and osteogenesis. 5,11,12 The problem of inferior alveolar nerve injury can be minimized by creating a bony window to house the inferior alveolar neurovascular bundle, surgical repositioning of the neurovascular bundle posteriorly and creating enough room for ostectomy in presurgical orthodontic treatment, which also reduces the incidence of root damage and encroachment of periodontal space of adjacent teeth. 4,12 We performed the osteotomy 2 mm anterior and superior to the mental foramen to compensate for the anterior loop of distal mental neurovascular bundle as it exits the foramen, and observed no neurosensory disturbance after a week of surgery.…”

“…The favourable fracture pattern with this osteotomy is physiologic to both the elevator and depressor muscles of jaws and minimum stabilization is required after surgery. 2,11 Cheung et al in their contemporary long term followup and evaluation of mandibular step osteotomy patients for complications found out that only 0.98% of teeth required endodontic treatment post-surgery, average periodontal probing was only 5mm which can be classified as mild periodontal disease, there was no significant difference in maximal mouth opening between normal patients and patients treated with MSO but the lateral excursion was significantly reduced in MSO patients. 13 This can be attributed to the change in the spatial position of the condylar head during adjustment of posterior segments to improve the crossbite and arch form.…”