Open Versus Closing Wedge Osteotomy and Application to Mandibular Reconstruction

Abstract

Purpose: To review the specific techniques of closing wedge osteotomy and open osteotomy, compare their clinical and radiographic outcomes, and apply these findings to mandibular reconstruction. Methods: A thorough review of the otolaryngology, facial plastic and reconstructive surgery, oral and maxillofacial surgery, and orthopedic surgery literature was conducted in the Ovid MEDLINE, EMBASE, and Google Scholar databases using the terms ‘osteotomy’ and ‘mandibular reconstruction.’ Results: Traditionally, open osteotomies were thought to result in greater rates of malunion. However, multiple meta-analyses within the orthopedic literature have refuted this. Closing wedge osteotomies, on the other hand, may increase the chance of damaging a perforator. Again, no studies have evaluated the relationship between type of osteotomy and flap survival or wound healing. The particular type of osteotomy performed often depends on the type of osseous flap being utilized. Conclusions: Open osteotomies are a viable and even preferred alternative, particularly in flaps without consistent perforators, such as scapular free flaps.