Assessment of Mandibular Canal Using Cone-Beam Computed Tomography (CBCT) and Its Relevance in Post-Operative Neurosensory Disturbances Following Bilateral Sagittal Split Osteotomy Setback.

AIM: Damage to the inferior alveolar nerve (IAN) during bilateral sagittal split osteotomy (BSSO) causes neurosensory disturbances (NSD) of the lower lip and chin. The study aims to investigate the pre-operative position and course of the mandibular canal using cone-beam computed tomography (CBCT) and orthopantomogram (OPG) and compare if there is any difference in NSD following the BSSO setback procedure. MATERIALS AND METHODS: This is an observational study. This study was conducted in the Department of Oral and Maxillofacial Surgery, Mar Baselios Dental College, Kothamangalam, from November 2017 to October 2019. Thirty patients undergoing BSSO setbacks are selected based on the inclusion and exclusion criteria and randomly grouped into two groups - group A (15) and study group B (15). OPG was done for both groups as it was required during surgical orthodontic evaluation and preoperative assessment of the mandibular canal was done using CBCT in group B. Neurosensory assessment was done in all the patients and compared the results. RESULTS: NSD were reported in all the patients on the first postoperative day. The correlation between subjective and objective evaluation showed absolute coincidence but nearly all the patients returned to their presurgical situation within six months in group B and one year in group A who had NSD problems. CONCLUSION: From the study, it can be concluded that a CBCT scan is a useful and reliable modality in the pre-operative evaluation of the mandibular canal in patients undergoing BSSO setback procedures, which helps to improve the patient's post-operative care and quality of life.

Comparative assessment of osteotomy cut using bur and saw for bilateral sagittal split osteotomy of mandible: a prospective clinical study.

PURPOSE: To compare the intraoperative utility of bur and saw and to examine the pattern of lingual split during bilateral sagittal split osteotomy of mandible. MATERIAL AND METHODS: This study prospectively compares the intraoperative utility of bur and saw in bilateral sagittal split osteotomy as split-mouth model. Study includes 16 patients (representing 32 sagittal split osteotomies) divided into two groups. The procedure to be performed was explained to the patient, followed by written informed consent. The institutional ethical committee approved the clinical study and all subjects gave informed consent. RESULTS: We found that the ease of handling of the bur was good compared to saw. The duration required for completion of osteotomy using bur was less compared to saw. CONCLUSIONS: The use of surgical drills and burs is still the gold standard in most developing nations and countries in transition like India. Depending upon the expertise of the surgeon, availability of precise dissecting instruments, one can go with either of the instrument for BSSO.

Patient discomfort and other side effects after bilateral sagittal split osteotomy or distraction osteogenesis of the mandible: a randomized clinical trial.

A randomized clinical trial was conducted to compare bilateral sagittal split osteotomy (BSSO) with distraction osteogenesis (DO) for the advancement of the mandible, with a focus on patient discomfort, postoperative pain, the need for analgesics, and occurrence of infection. All patients were non-syndromal, had a class II hypoplastic mandible, and had not undergone previous mandibular surgery. A total of 66 patients were allocated randomly to the BSSO group (32 patients) or the DO group (34 patients). Sixty-three patients were eligible for evaluation, 29 in the BSSO group and 34 in the DO group. Patients in the DO group experienced more pain after 6 days postoperative, and were administered more analgesics after 5 days postoperative than patients in the BSSO group (P=0.030 and P=0.045, respectively). The operating time was significantly shorter for the BSSO group than for the DO group (78 min vs. 100 min, P=0.024). All postoperative infections (12 in total) emerged in the DO group (P=0.005). All patients in the DO group had a second surgery in day care to remove the distractor, while two patients in the BSSO group needed plate removal. It is concluded that patients experienced more pain after DO, needed more analgesics postoperatively, and had more infections in comparison to the BSSO group.