Department of Oral and Maxillofacial Surgery, School of Dentistry, Medipol University, Istanbul, Turkey.
J Craniofac Surg. 2021;32(5):1712-1715. doi: 10.1097/SCS.0000000000007404.
Horizontal osteotomy is one of the most critical step at sagittal split ramus osteotomy (SSRO) and determination of the ideal height of this horizontal osteotomy is essential to avoid nerve and vessel injury.
The aim of this study was to evaluate the level of the medial horizontal ramus cut as a risk factor for unfavorable outcomes in the SSRO.
Sixty-four patients with dentofacial deformity who applied to Oral & Maxillofacial Surgery Department between August 2018 and August 2019 and undergone orthognathic surgery were evaluated. Out of 64, 49 patients had SSRO with or without maxillary surgery and genioplasty. Twenty-six patient had postoperative computed tomography scan with 6-months follow-up. Finally, 26 patient with 52 SSRO sides were included in this study. Computed tomography scans were evaluated and classification according to osteotomy levels was made. Postoperative neurosensory deficit, bleeding, and intraoperative complications such as bad split, visible damage to inferior alveolar bundle were assessed. Age, gender, neurosensory deficit, bad splits were analyzed and correlated with the level of the osteotomies.
Fifteen osteotomies were above lingula, 24 between apex and base of lingula, and 14 below lingula. One bad split occurred, and no visible damage to the inferior alveolar bundle was seen. There was no significant difference between osteotomy groups in terms of visual analogue scale (VAS) scores (P > 0.05) but in all groups; women's VAS scores are statistically significantly higher than men. (P: 0.036).
There is no correlation between the horizontal osteotomy level and intraoperative or postoperative complications. The low medial horizontal osteotomy can be safely performed in SSRO.
水平截骨术是矢状劈开下颌支骨切开术（SSRO）中最关键的步骤之一，确定这种水平截骨术的理想高度对于避免神经和血管损伤至关重要。
本研究旨在评估内侧水平支骨切开的水平作为 SSRO 不良结果的危险因素。
评估了 2018 年 8 月至 2019 年 8 月期间向口腔颌面外科就诊并接受正颌手术的 64 例牙颌面畸形患者。在 64 例患者中，49 例行 SSRO 联合或不联合上颌手术和颏成形术。26 例患者术后行 CT 扫描并随访 6 个月。最终，本研究纳入了 26 例患者的 52 侧 SSRO。对 CT 扫描进行评估，并根据截骨水平进行分类。评估术后神经感觉缺陷、出血以及术中并发症，如劈裂不良、下牙槽束可见损伤。分析年龄、性别、神经感觉缺陷、劈裂不良与截骨水平的关系。
15 例截骨位于 Lingula 上方，24 例位于 Lingula 根尖和基底部之间，14 例位于 Lingula 下方。发生 1 例劈裂不良，未见下牙槽束明显损伤。各截骨组之间的视觉模拟评分（VAS）无显著差异（P>0.05），但在所有组中，女性的 VAS 评分均显著高于男性（P：0.036）。
水平截骨位置与术中或术后并发症之间无相关性。在 SSRO 中可以安全地进行低位内侧水平截骨。
