Sagittal Split Osteotomy: Procedure & Recovery
Sagittal split osteotomy is a jaw surgery procedure used to correct misalignment of the lower jaw, improving chewing function, speech, and facial aesthetics.
Things worth knowing about "Sagittal Split Osteotomy"
Sagittal split osteotomy is a jaw surgery procedure used to correct misalignment of the lower jaw, improving chewing function, speech, and facial aesthetics.
What is a Sagittal Split Osteotomy?
A sagittal split osteotomy – also known as Bilateral Sagittal Split Osteotomy (BSSO) – is an oral and maxillofacial surgical procedure in which the lower jaw (mandible) is carefully cut and repositioned to correct a misalignment. It is one of the most commonly performed orthognathic (jaw-correcting) surgeries worldwide and is used when orthodontic treatment alone cannot fully correct a jaw discrepancy.
Indications: When is this Procedure Used?
The sagittal split osteotomy is indicated when the lower jaw is structurally malpositioned. Common reasons for this procedure include:
- Prognathism: excessive protrusion of the lower jaw (underbite)
- Retrognathia: excessive retrusion of the lower jaw (overbite)
- Laterognathia: lateral displacement of the lower jaw
- Malocclusion affecting chewing and bite function
- Obstructive sleep apnea (often combined with advancement of both jaws)
- Facial aesthetic improvements and profile correction
How is the Procedure Performed?
The surgery is carried out under general anesthesia and typically takes two to four hours. All incisions are made inside the mouth, so there are no visible external scars on the face.
Surgical Steps
- Incision through the oral mucosa to expose the mandibular bone
- Controlled osteotomy (bone cut) along the sagittal plane of the mandibular ramus
- Precise repositioning of the lower jaw segment into the pre-planned target position
- Stabilization of the bone segments using titanium screws and plates
- Closure of the mucosal incisions
Preoperative planning involves dental model analysis, digital 3D planning using CT scan data, and orthodontic preparation typically lasting 12 to 24 months.
Preoperative Orthodontic Treatment
Before surgery, a period of fixed orthodontic treatment (braces) is usually required to align the teeth optimally for the new jaw position. After surgery, orthodontic treatment continues for several months to refine and stabilize the result.
Recovery and Healing
Following surgery, patients typically require a hospital stay of two to five days. Full bone healing takes approximately six to twelve months. Important aspects of the recovery phase include:
- Soft diet: Solid foods must be avoided for several weeks after surgery
- Pain and swelling management: Ice packs and pain medication as prescribed
- Physiotherapy: Jaw exercises to restore full range of motion
- Regular follow-up appointments with the orthodontist and surgeon
Risks and Possible Complications
As with any surgical procedure, sagittal split osteotomy carries certain risks, including:
- Numbness or altered sensation in the chin and lower lip due to stretching or temporary injury of the inferior alveolar nerve – usually temporary, rarely permanent
- Postoperative bleeding and infection
- Incomplete or delayed bone healing (uncommon)
- Relapse toward the original jaw position (recurrence)
Outcomes and Prognosis
With careful planning and execution, the sagittal split osteotomy produces excellent long-term results in the vast majority of patients. Most report significant improvements in chewing function, speech clarity, and facial profile, along with an overall improvement in quality of life and self-confidence.
References
- Proffit WR, White RP, Sarver DM: Contemporary Treatment of Dentofacial Deformity. Mosby Elsevier, 2nd edition, 2003.
- Epker BN: Modifications in the sagittal osteotomy of the mandible. Journal of Oral and Maxillofacial Surgery, 35(3):157–159, 1977. PubMed PMID: 264333.
- Hunsuck EE: A modified intraoral sagittal splitting technic for correction of mandibular prognathism. Journal of Oral Surgery, 26(4):250–253, 1968. PubMed PMID: 5238842.
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