Falter Bart, Schepers Serge, Vrielinck Luc, Lambrichts Ivo, Thijs Herbert, Politis Constantinus
Oral and Maxillofacial Surgery, St. John's Hospital, Genk, Belgium.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Oct;110(4):430-5. doi: 10.1016/j.tripleo.2010.02.003. Epub 2010 May 8.
The objectives of this study were to determine the incidence of bad splits in sagittal split osteotomies (SSOs), performed at the same hospital, and if the occurrence was reduced over time because of technical progress and/or surgical experience. Bad splits were defined as buccal or lingual plate fractures.
The files of all patients (n = 1008) who underwent bilateral or unilateral SSO between October 1989 and October 2009 were reviewed retrospectively.
A bad split occurred in 14 SSO sites (14 of 2005 sites). No bilateral bad splits occurred. There was no notable decrease of bad splits over the 20 years. All bad splits were resolved perioperatively by plate-osteosynthesis without the additional need of intermaxillary fixation. All patients with a bad split had a good and functional occlusion 6 months postoperatively. No infections occurred at the site of the bad splits. No bad splits occurred in patients younger than 20 years. No particular type of dental-facial deformity, or skeletal class according to the Angle's classification could be correlated with cases of bad splits as a predisposing risk factor.
Even if precautions are taken, a bad split can occur during SSO of the mandible. This complication is manageable because of its low incidence (0.7 % of all SSOs) and uneventful healing. A significant decrease in incidence did not occur during the 20-year period, and neither technical progress nor the surgeon's experience further reduced the incidence of bad splits.
本研究的目的是确定在同一家医院进行的矢状劈开截骨术（SSO）中不良劈开的发生率，以及由于技术进步和/或手术经验，这种情况的发生率是否随时间降低。不良劈开定义为颊侧或舌侧骨板骨折。
回顾性分析了1989年10月至2009年10月期间接受双侧或单侧SSO的所有患者（n = 1008）的病历。
2005个SSO部位中有14个出现不良劈开（14个部位）。未发生双侧不良劈开。在这20年中，不良劈开的发生率没有显著下降。所有不良劈开均在围手术期通过钢板内固定解决，无需额外的颌间固定。所有发生不良劈开的患者术后6个月均有良好且功能正常的咬合。不良劈开部位未发生感染。20岁以下患者未出现不良劈开。根据安氏分类，没有特定类型的牙颌面畸形或骨骼类型与不良劈开病例相关联作为易感危险因素。
即使采取了预防措施，在下颌骨SSO过程中仍可能发生不良劈开。由于其发生率低（占所有SSO的0.7%）且愈合顺利，这种并发症是可控的。在20年期间，发生率没有显著下降，技术进步和外科医生的经验均未进一步降低不良劈开的发生率。
