Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy

Smith, Brian R.; Rajchel, Jeffrey L.; Waite, Daniel E.; Read, Lance

doi:10.1016/0278-2391(91)90095-4

Cited by 60 publications

(44 citation statements)

References 7 publications

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“…It is thus believed that in the human mandible with its complex morphology, the fracture lines tend to run through those parts that have poorer physical strength, that is, the parts between the lamellae, or the part with a poor bonding strength. It is also believed that the morphology (shape) of the bone has little infiuence 4,11,12) . Morphological studies based on 3-dimensional visualization were previously carried out using the familiar conventional tracing paper 7,8) and sketching technique by superimposing rubber sheets.…”

Section: Discussionmentioning

confidence: 99%

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Course of Fracture Line in Sagittal Splitting of Human Mandible

Hanaue

Katakura

Kasahara

et al. 2007

Bull. Tokyo Dent. Coll.

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We performed sagittal splitting osteotomy using fresh, unfixed cadavers. Observation was carried out macroscopically and with light microscopy and 3-dimensionally reconstructed images. The aim of this study was to clarify the relationship between the fracture line and the Haversian canal and Haversian lamellae. Macroscopic observation revealed that the fracture line run through the mandibular angle from the inferior rim of the mandibular ramus towards the posterior rim, passing almost through the center of the ridgeline. Histological observation showed that the fracture line tended to run along the curve of the lamellar structure. The incidence of the fracture line running along the lamellar structure of the Haversian lamellae was approximately 65% (21 cases), and the incidence of the fracture line also cutting across the Haversian canal without passing along the lamellar structure of the Haversian lamellae was approximately 35% (11 cases). Observation of 3-dimensional reconstruction images revealed that the section of Haversian canal near the mandibular angle essentially runs from the mandibular head to the inferior rim of the mandible, and that the fracture plane ran similarly. The direction of an impact-associated bone fracture line is infiuenced by the structures that constitute the lamellar bone such as Haversian canals, Haversian lamellae and interstitial lamellae, with fracture lines tending to run through those parts of the bone that have a low physical bond strength. This suggests that the ideal direction of action of the bone chisel in sagittal splitting surgery is the one in which no resistance to the path of the Haversian canal is encountered.

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Section: Discussionmentioning

confidence: 99%

“…This suggests that the mandible has an orientation and structure which make it easy for the fracture line of the mandible to propagate 2,10,12) . A report from an earlier study showed that the fracture line run in a specific direction in long bone 5,11) .…”

Section: Introductionmentioning

confidence: 99%

Course of Fracture Line in Sagittal Splitting of Human Mandible

Hanaue

Katakura

Kasahara

et al. 2007

Bull. Tokyo Dent. Coll.

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“…SSRO normally requires a horizontal osteotomy in the medial aspect of the mandibular ramus, which most frequently is performed above the mandibular foramen and at a level below that where both buccal and lingual cortical bone layers merge. The distinct feature of the lingula on the medial aspect of the mandibular ramus, makes it a very convenient landmark for referring the level of cortical merge (Smith et al, 1991), for example, reports that the fusion of both cortical structures occurs 7.5 to 13.3 mm above the lingula.…”

Section: Discussionmentioning

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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“…An unfavorable fracture, called a "bad split" although infrequent in the hands of an experienced operator, occasionally develop and can lead to intraoperative difficulties as well as postoperative relapse [43]. Frequently cited reasons for bad split include incomplete osteotomies, using osteotomes that are too large, attempting to split the segments too rapidly presence of impacted third molars, misdirecting the medial osteotomy upward toward the condyle and placement of the medial osteotomy too far superior to the lingula [44].…”

Section: Unfavorable Splitmentioning

confidence: 99%

Complications in Orthognathic Surgery

Capone¹,

Sykes²

2012

Complications in Facial Plastic Surgery

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Orthognathic surgery is a common approach for treatment of maxillofacial deformities. Sagittal split ramus osteotomy (SSRO) is one of the most common techniques used to treat various mandibular deformities. A LeFort I osteotomy is suggested in deformities of the maxilla and can be used along with SSRO or intra-oral vertical ramus osteotomy (IVRO).The aim of orthognathic surgery is to improve function and facial appearance; this benefits the patient psychologically and socially. Common complications which may occur in orthognathic surgery include vascular disease, temporomandibular joints (TMJ) problems, nerve damage, infection, bone necrosis, periodontal disease, vision impairment, hearing problems, hair loss, and neuropsychiatric problems. Rarely complications could be fatal. Because of the wide range of complications the surgeon should keep prevention protocols in mind and be prepared to treat them should they occur. In this chapter, common complications of various osteotomies in the mandible and maxilla are discussed.

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Mandibular ramus anatomy as it relates to the medial osteotomy of the sagittal split ramus osteotomy

Cited by 60 publications

References 7 publications

Course of Fracture Line in Sagittal Splitting of Human Mandible

Course of Fracture Line in Sagittal Splitting of Human Mandible

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

Complications in Orthognathic Surgery

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