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Objectives: This study aimed to analyse the changes in soft tissue and hard tissue stability associated with the split pattern, i.e. long split (LS) or short split (SS), after sagittal split osteotomy. Materials and methods: Patients who underwent sagittal split ramus osteotomy were classified into LS or SS groups according to postoperative computed tomography images. They were examined via lateral cephalography and three-dimensional (3D) optical scanning before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Six standard angles (SNA, SNB, ANB, FMA, FMIA, and IMPA) were used as measures of hard tissue change. The two sets of 3D data were superimposed, and the volumetric differences were calculated as the soft tissue change. The areas evaluated were delimited by 10 × 20-mm rectangles in the frontal aspect and a 25 × 25-mm square in the lateral aspect. Results: A total of 42 sides (26 patients) were analysed, including 20 (16 patients) in the SS group and 22 (16 patients) in the LS group. We found no significant differences in cephalographic angle or soft tissue changes in the frontal aspect between the SS and LS groups. We found significant differences in the subauricular region from T0–T1 (p = 0.02), T0–T2 (p = 0.03), and T0–T3 (p = 0.037) in terms of soft tissue changes in the lateral aspect. The volume increase associated with posterior mandibular movement was greater in the LS group. Conclusions: We found that LS patients with mandibular prognathism exhibited increased subauricular volumes following mandibular setback. Clinical relevance: It is essential to predict the postoperative facial profile before surgery. The split pattern after sagittal split osteotomy affects the postoperative profile of patients with mandibular prognathism. [ABSTRACT FROM AUTHOR]

Introduction: Defects in the lower border of the mandible may represent an aesthetic problem after mandibular advancement in orthognathic surgery. The use of bone grafts has been reported in the literature as a possibility to reduce these defects in the postoperative period. Objective: The objective of this systematic review is to answer the following research question: Is it necessary to use bone grafts to prevent defects at the lower border of the mandible after mandibular advancement? Methods: The literature search was conducted on MEDLINE via PubMed, Scopus, Central Cochrane, Embase, LILACS, and Sigle via Open Gray up until December 2020. Five studies were eligible for this systematic review, considering the previously established inclusion and exclusion criteria. Results: 1340 mandibular osteotomies were evaluated, with a mean advance of 8 mm, being 510 with bone graft (42 defects), 528 without graft (329 defects), and 302 with an alternative technique (32 defects). Regarding the type of bone graft used, three articles used xenogenous or biomaterial grafts and two allogenous bone grafts. The results of the meta-analysis showed a reduction in the presence of defects in the bone graft group: OR 0.04, 95% CI = 0.01, 0.19; p = 0.0005, (I2 = 87%; p < 0.0001). Conclusion: The use of bone grafts seems promising in reducing defects in the lower border of the mandible after mandibular advancement. New controlled prospective studies with a larger number of participants are needed to ensure the effectiveness of this procedure. [ABSTRACT FROM AUTHOR]

The integration of virtual surgical planning (VSP) for the treatment of skeletal, dental, and facial abnormalities and obstructive sleep apnea (OSA) with maxillofacial surgery has catapulted surgical planning. Although reported for treating skeletal-dental abnormalities and dental implant surgery, a paucity of knowledge existed reporting the feasibility and resultant outcome measures when VSP was employed for planning maxillary and mandibular surgery for OSA patients. The surgery-first approach is at the forefront of advancing maxillofacial surgery. Case series reporting success with the surgery-first approach for patients with skeletal-dental and sleep apnea patients have been reported. In sleep apnea patients, clinically significant reductions in apnea-hypopnea index and improvement of low oxyhemoglobin saturation have been achieved. More so, significant improvement in the posterior airway space at the occlusal and mandibular planes were achieved, while preserving aesthetic norms as measured by tooth to lip measurements. VSP is a feasible tool used for predicting surgical outcome measures in maxillomandibular advancement surgery for patients with skeletal, dental, facial, and OSA derangements. [ABSTRACT FROM AUTHOR]

The secondary treatment of mandibular bone fractures poses a great challenge due to the complexity of several factors, such as incorrect primary fracture repositioning, inadequate internal fixation, nonunion, necrosis, local inflammation and infection, tooth loss, and malocclusion, serving as obstacles encountered by surgical teams. The aim of this case report is to detail the planning process, surgical technique, and outcome of the secondary treatment of the post-traumatic deformation, bone exposure, and partial necrosis of the mandible. The new approach described herein incorporated 3D planning and printing procedures, employing surgical techniques such as the segmentation of the mandible with unilateral sagittal split osteotomy and the vertical osteotomy of the mandibular body. New, stable occlusion; appropriate spatial relations; and proper osteosynthesis of the mandible were achieved. The encouraging results obtained demonstrate that the described method can be incorporated in similar cases of the secondary treatment of mandibular fractures and possibly lead to shorter hospitalization and convalescence and lower the associated costs. [ABSTRACT FROM AUTHOR]

This study examines the effect of the lateral bone cut end (LBCE) on the pattern of lingual split during bilateral sagittal split osteotomy (BSSO) in patients with skeletal class III malocclusion. A case-control study according to the pattern of the sagittal split osteotomy (SSO) lingual split line was conducted in patients who underwent BSSO. The primary predictor variable was the ratio of the LBCE. The primary outcome variable was the type of lingual fracture line classified according to the lingual split scale (LSS). Other variables included patients' weight, sex, age, left and right sides of the mandible, and experience of the surgeon. Logistic regression analysis or the chi-squared test was performed to determine the effect of these variables on various types of lingual fracture line. The significance level was 95% (p < 0.05). There were 271 patients enrolled in this study. The SSO lingual split lines were divided into LSS1 (329/542), LSS2 (82/542), LSS3 (93/542), and LSS4 (38/542) splits. Logistic regression analysis showed that the LSS3 split was more likely to appear when the LBCE was closer to the lingual side (p = 0.0017). The age of patients significantly affected the possibilities of LSS2 (p = 0.0008) and LSS3 (p = 0.0023) splits. A LBCE close to the lingual side was an inducer for the formation of a LSS3 split in patients with skeletal class III malocclusion during BSSO. The age of the patient also affected the possibility of LSS2 and LSS3 splits. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to find out the correlation between different anatomical parameters of the mandible and the occurrence of a bad split in patients who had undergone bilateral split sagittal ramus osteotomy (BSSRO). Materials and method: At both the distal roots of the first molar (1) and the retromolar area (2), we measured the distance from the buccal margin of the inferior dental canal (IDC) to the buccal margin of the cortical bone (MCBC), the thickness of both buccal cortical (WBCB) and cancellous bone (WBCA), distance from the superior border of IDC to the alveolar crest (MCAC), buccolingual thickness (BLT), and thickness of cancellous bone (WCA). At the ramus, the distances between the sigmoid notch to the upper part of the lingula (SL) and the inferior border of the mandible (SIBM), the thickness of the ramus at the level of the lingula (BLTR), and the anteroposterior width of the ramus (APWR) were measured. The paired and independent t-tests were used when applicable, and a P-value < 0.05 was considered significant. Results: MCBC1 showed a significant difference between bad and non-bad split sides (P = 0.037). Both WBCA1 and WBCA2 show the same significant difference (P = 0.023, 0.024). Similarly, WCA1 and WCA2 showed a statistical difference between the bad and non-bad split sides (P = 0.027, 0.036). There were no statistically significant differences between the compared sides of WBCB1, WBCB2, MCAC1, MCAC2, SIBM, APWR, SL, and BLTR. Conclusion: Narrow space between IDC and the buccal cortical margin, along with the decrease in the thickness of both buccal cancellous bone and total cancellous bone at the inferior border of the mandible along the course of SSRO, has been implicated in the occurrence of bad split intraoperatively. [ABSTRACT FROM AUTHOR]

An unfavourable split is a well-known complication following a sagittal split osteotomy (SSO) of the mandible. Our aim was to analyse all unfavourable mandibular splits that had occurred when carrying out a SSO with the aim to design a classification which can facilitate management. We carried out a retrospective study analysing all orthognathic surgery from January 2010 until April 2021. Data surrounding unfavourable splits during this period were specifically analysed. Orthognathic surgery during this period was performed by a single OMFS unit with osteotomies performed by a single surgeon and their trainee. The dataset included 311 patients who underwent either a bilateral sagittal split osteotomy (BSSO) or a bimaxillary osteotomy. There were 225 bimaxillary osteotomies and 86 BSSOs. Twenty-one patients had unfavourable splits following their BSSO with a total of 22 out of 622 sagittal split osteotomies over this 11-year period. Bilateral unfavourable splits occurred in one patient. These results correlate to an incidence rate of 6.8% of unfavourable splits following SSO's in an 11-year period. The results reveal common patterns of unfavourable splits to suggest a simple classification based on our results. This can be applied to any unfavourable splits in SSO which then allows the clinician to proceed with surgery and prevent abandonment of the procedure. It is classified as follows: Type 1 fractures where the mandibular condyle is attached to the proximal fragment; Type 2 fractures whereby the mandibular condyle is attached to the tooth-bearing segment; Type 3 fractures are lingual cortex fractures. Each of these fracture types has a specific management protocol, which we recommend is used in all unfavourable splits. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy of sagittal split plate with adjustable slider for intra-operative correction of condylar sag after bilateral sagittal split osteotomy. Subjects and Methods: Patients reporting for correction of mandibular skeletal deformities for correction with sagittal split osteotomy (SSRO) were enrolled in the study. Simple randomization method was followed for patient allocation. Patients in group A had undergone fixation sagittal split fix plates; in group B, miniplate fixation with monocortical screws was used. Occlusion was the key indicator of condylar sage that was checked at different time frames (intra-operatively T0, immediate T1, 6 months postoperatively T2). Preoperative, immediate and late postoperative (at 6 months and 1-year interval) and lateral cephalometric assessment was used to assess their stability. Results: Thirty-three patients were enrolled and 20 patients were included in the study. One patient of group A presented with central condylar sag that was identified intra-operatively and addressed immediately. All the patients in group B presented with type 2 peripheral condylar sag that was addressed by inter-maxillary elastics and orthodontics. Two patients in group A presented with mild degree of relapse at 6 months, which was comparable to the control group indicating good stability. Conclusion: Sagittal split plates appear to be efficacious for intra-operative identification and correction of condylar sag is associated with SSRO. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy of modified distraction osteogenesis via intraoral approach and distraction osteogenesis via extraoral approach in the treatment of hemifacial microsomia (HFM) in childhood. Methods From January 2015 to January 2021, 52 children with HFM were selected according to the inclusion criterion. The data of preoperative and postoperative head CT in all children were collected. In these children, 22 cases underwent modified distraction osteogenesis via intraoral approach (intraoral group) and 30 cases underwent distraction osteogenesis via extraoral approach (extraoral group). The three-dimensional measurement of length, width and thickness of mandibular ramus was performed by Proplan 3.0 software. Statistical analysis of the three-dimensional measurement index was also conducted. All children were followed-up for 6 to 24 months. Results The facial asymmetry was significantly improved in both groups. The extension of mandibular ramus length in the extraoral group was significantly improved compared with the intraoral group (P<0.05). There was no statistical significance between intraoral group and extraoral group in terms of thickness of mandibular ramus (P>0.05). In the maintenance of width of mandibular ramus, the intraoral group was significantly improved compared with extraoral group (P<0.05). The scar scores in the intraoral group was significantly lower than that in the extraoral group (2.0:8.1). Conclusion Two methods of distraction osteogenesis have their own advantages. Therefore, to acquire the best clinical efficacy, surgeons should select the suitable method according to the actual situation of children with HFM. [ABSTRACT FROM AUTHOR]

Study Design: Case Report. Objective: To present a case of a previous complicated mandibular orthognathic surgery that aimed to setback the mandible in a female cleft lip and palate (CLP) patient, which led to bone necrosis on one side with subsequent severe mandibular deviation and facial asymmetry. We additionally reviewed the previous reports of similar complications, the pathophysiology and the factors that could lead to this dreadful result. Method: A 27-year-old female patient presented with a severe dentofacial deformity secondary to a complicated bilateral sagittal split ramus osteotomy performed five years earlier, which resulted in aseptic bone necrosis on the right side. The patient had marked mandibular deviation, chin and midface retrusion and a pronounced occlusal discrepancy. Imaging demonstrated a bony defect at the right mandibular angle with a superiorly displaced proximal segment. Deviation of the mandible was corrected first by performing vertical ramus subsigmoid osteotomy (RSO) on the left side. The right bone defect was then reconstructed with a reconstruction plate and bone grafting. Maxillary and chin advancement was performed at a second stage. Results: On follow-up, the patient shows a significant improvement in facial esthetics and mandibular symmetry and is currently under orthodontic management to enhance the occlusal relationship. Conclusion: Bone necrosis is a rare but dreaded problem in orthognathic surgery. Minimizing the musculo-periosteal dissection and competent execution of the bone osteotomy is substantially effective in reducing the risk of bone ischemia and necrosis. [ABSTRACT FROM AUTHOR]

Orthognathic surgery performed in conjunction with orthodontic treatment is commonly performed to correct skeletal irregularities and realign the maxillomandibular relationship to improve occlusal function and facial esthetics. A thorough understanding of soft tissue esthetics, skeletal and occlusal relationships, and surgical techniques is required to obtain successful results. Surgical techniques have evolved greatly throughout history, as technological advances such as virtual surgical planning have become available and widely used to obtain predictable movements with minimized complications. The aim of this article is to review the orthognathic surgical procedures of the mandible, with particular attention to the indications, contraindications, preoperative assessment, surgical technique, and possible complications encountered. [ABSTRACT FROM AUTHOR]

Purpose: Although bilateral sagittal split osteotomy (BSSO) is the most widely used surgical technique for the correction of mandibular dentofacial anomalies, it is associated with lesion of inferior alveolar nerve (IAN) and unwanted neurosensory disorders. The aim of this study was to document the perception of changes in sensitivity and mean recovery time after BSSO, using an ultrasonic BoneScalpel versus the conventional rotary instruments. Patients and methods: This retrospective observational study included all patients with diagnosis of skeletal anomaly who underwent advancement or setback BSSO of less than 10 mL, using the ultrasonic osteotome or conventional rotary instruments. The patients were operated on at the Hospital Universitario Clínica San Rafael, Bogotá Colombia, between 2017 and 2018. The primary predictor variable was the osteotomy technique. The primary outcome was the presence or absence of postoperative sensory alteration, whereas secondary outcomes were time of appearance and recovery, affected anatomical region, laterality, and disturbance in daily activities. Data were analyzed using Chi-square, Mann-Whitney U, and Fisher's exact test. Results: Data of 38 patients were retrieved, of which 23 were operated with BoneScalpel and 13 with the conventional technique. Twenty patients were women and 18 were men. All patients reported experiencing at least one type of sensory disturbance immediately after the surgical procedure. There was a significant difference (p = 0.0001) in the time that the alteration was present between the two groups, in favor of the BoneScalpel group. The chin and the lower lip were the anatomical regions with the greatest alteration in sensitivity and persistence of it. Conclusions: The results of this study indicate that BoneScalpel is effective in performing BSSO. They also suggest that it may reduce the occurrence of nerve damage during BSSO, although more research on this topic is required. [ABSTRACT FROM AUTHOR]

The retrospective cohort study aimed to assess the incidence and characteristics of these complications in patients who underwent orthognathic procedures. Data on the intraoperative and the postoperative complications were extracted from the patients' medical files. Procedures were further subdivided into single-jaw procedures and bimaxillary procedures. A total of 209 orthognathic procedures were carried out in 190 patients. 184 (88%) were performed to treat angle class III malocclusion, while 25 (12%) aimed to treat class II malocclusion. A total of 94 complication events were observed (44.9% of 209 procedures). 22 of them occurred in single-jaw procedures (28.2% of 78 single jaw operations), and 72 occurred in bimaxillary procedures (55% of 131 bimaxillary operations). When compared regarding the type of complication, complication rates were comparable between the study groups with the exception of late-stage malocclusion. A significant difference (p-value = 0.028) in malocclusion incidences between the bimaxillary and single-jaw groups were observed (9 events, 4.3% and zero events, 0%, respectively). The majority of the complications during and following orthognathic surgical procedures are temporary or minor and require little or no treatment at all. [ABSTRACT FROM AUTHOR]

Introduction: There are various alternative surgical approaches for removal of large benign lesions in the posterior part of the mandible. This study describes three cases of large mandibular mixed odontogenic lesions which were excised via sagittal split approach. Report of Cases: All three cases were treated by surgical excision via unilateral sagittal split osteotomy under general anesthesia following a 2 weeks period of intermaxillary fixation. Results: The lesions were enucleated completely and all three osteotomy sites healed with no consequences with an intact neurosensory function. Conclusion: This article suggests the sagittal split osteotomy approach for conservative treatment of large mandibular lesions based on excellent access, limited bone removal and reducing further complications.

Aim: Compare two regimens of antibiotic prophylaxis on the development of surgical site infection (SSI) following mandibular advancement with bilateral sagittal split osteotomy (BSSO). Materials and methods: In total, 176 patients were included. Two antibiotic regimens were administered intravenously. The first 114 patients were given penicillin V (PcV) in three doses every 8 h (PcV3‐group), and the next 62 patients were given PcV in four doses every 6 h (PcV4‐group). The same surgical protocol was followed for all patients. Development of SSI was registered at follow‐up 2 months and 1 year after surgery. Results: A significant reduction in the rate of SSI was found in the PcV4 group compared to the PcV3‐group (P = 0.012). The infection rates were 4.8% and 19.3% respectively. A higher prevalence of SSI was found when mandibular wisdom teeth were present, but this was not statistically significant. There were no correlations between gender, age, intraoperative bleeding and operation time and the development of SSI. None of the patients developed severe infection. Conclusion: The infection rate was significantly reduced when PcV was administered in four doses, suggesting that an extended regimen of antibiotic prophylaxis is beneficial when performing mandibular advancement with BSSO. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the pre- and postoperative position and dimensions of the inferior alveolar canal (IAC) following sagittal split osteotomy (SSO) and identify any association with postoperative neurosensory deficit (NSD) at 1 year. This retrospective cohort study enrolled consecutive patients who had SSO performed to correct skeletal malocclusion. The pre- and postoperative cone beam computed tomography data were superimposed to visualize differences in IAC position and dimensions. Subjective and objective neurosensory tests were used to determine NSD in the inferior alveolar nerve distribution. A total of 20 subjects were included. The preoperative distance from the lateral cortex of the IAC to the inner aspect of the lateral cortex of the mandible was significantly greater in sides with NSD when compared to sides without NSD (P = 0.01). A significantly greater reduction in the postoperative distance measurement was seen in sides with NSD when compared to sides without NSD (P = 0.01). The magnitude of mandibular movement was significantly increased in sides with NSD (P = 0.02). The preoperative location of the IAC, as well as certain changes in the mediolateral and vertical positions as a result of SSO, are risk factors for postoperative NSD. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to quantify the displacement of the proximal segment after bilateral sagittal split osteotomy in patients with class III asymmetry and evaluate if the displacement was related to the movement of the distal segment. Material and methods: Forty adults with class III asymmetry corrected by bimaxillary surgery were studied. Cone-beam computed tomography taken before and 1 week after surgery was used to measure the displacement of proximal segments and movement of the distal segment in terms of translation and rotation. The relationship between the displacemnt of the proximal segment and the movement of the distal segment was evaluated. Results: After surgery, the deviated proximal segment was displaced forward and to the deviated side, rotated downward, tilted, and turned to the opposite side. The opposite proximal segment was displaced forward and rotated downward. The roll rotation of the proximal segment was correlated with the left/right movement and roll rotation of the distal segment. Conclusion: Early after orthognathic correction for class III asymmetry, the deviated proximal segment was displaced in a direction favorable for correction of asymmetry. The roll rotation of the proximal segment was affected by the transverse movement and roll rotation of the distal segment. Clinical relevance: Knowledge of the ability and limitation of the proximal segment rotation improves the virtual simulation. [ABSTRACT FROM AUTHOR]

We have investigated the long-term incidence of neurosensory disturbances after modified bilateral sagittal split osteotomy, and identified associated risk factors. We prospectively studied 376 patients, and their self-reported neurosensory disturbances were evaluated six months, and one, two, and three years postoperatively. The correlations between the following risk factors and neurosensory disturbances were investigated using univariate analysis and stepwise multivariate analysis: age at operation, sex, type of movement (advancement, setback, or rotation), concurrent genioplasty, type of detachment, iliac crest bone graft, and use of dicalcium phosphate synthetic bone graft. Probabilities of less than 0.05 were accepted as significant. Three years postoperatively, 57 patients (15%) reported altered sensation of the lower lip or chin. Older age correlated significantly with neurosensory disturbances (p < 0.0001). Greater mandibular advancement correlated with postoperative "positive" neurosensory phenomena (right side p = 0.08; left side p = 0.03). Intraoperative surgical manipulation of the left inferior alveolar nerve was significantly associated with postoperative hypoaesthesia (p = 0.014). Older age at surgery, extensive mandibular advancement, and surgical manipulation of the left inferior alveolar nerve, were associated with long-term neurosensory disturbances after modified bilateral sagittal split osteotomy. The modified operation seems to safeguard the inferior alveolar nerve from transection, without causing damage to other nerves. [ABSTRACT FROM AUTHOR]

The aim of this study was electromyographic description of changes in swallowing before and after bilateral sagittal split ramus osteotomy. In this prospective study, twenty-eight patients were divided into 3 groups according to the occlusion pattern: Group I (Angle Class III), Group II (Angle Class II), and Control (Class I). Serial cone-beam computed tomography analyses and electromyographic data were collected preoperatively, 1st and 6th months after setback surgery in Group I, and advancement surgery in Group II. Swallowing reflex with 3-20 ml water bolus were studied. Patients were further divided into two subgroups according to the magnitude of relapse. The mean setback of the mandible was 4.62 ± 1.92 mm in Group I, and the mean advancement was 4.19 ± 2.00 mm in Group II. Mandibular relapse rate was 17.40%. Oral preparation phase shortened after surgery in both study groups. Two subjects in Group II and one in Group I had piecemeal deglutition, and two of them became normal postoperatively. Most of the swallowing durations of the relapsed cases were longer than those of stabilized patients. Important clinical considerations are as follows: the oral preparation period becomes shorter after surgery; piecemeal deglutition may disappear after treatment; and individuals with a longer oral period and piecemeal deglutition may have increased tendency to skeletal relapse. This multidisciplinary study enhances our understanding of the adaptive response to the swallowing reflex after orthognathic surgery and provides novel insight into the association between the submental muscle activity and relapse in orthognathic patients. [ABSTRACT FROM AUTHOR]

Objectives: Maxillomandibular advancement (MMA) confers consistent and high rates of surgical success for obstructive sleep apnea (OSA). In the era of value-based medicine, identifying factors that affect the stability of rigid fixation and allow rapid return to function are important targets for improvement. The aim of this study was to identify patient and surgical factors associated with mandibular sagittal split outcomes associated with optimal postoperatively skeletal stability. Study design: Retrospective cohort study. Materials and methods: Forty-six subjects (43 males and 3 females) with postoperative CT scans including three-dimensional reconstruction from which mandibular split patterns could be analyzed were enrolled. Patient factors (age and polysomnographic measures) and surgical factors (extent of osteotomy prior to controlled fracture) were assessed. Outcome measures include (1) bone thickness for rigid fixation and (2) area of passive bony overlap after advancement. Results: Age and severity of disease did not contribute significantly to optimal mandibular split patterns. For optimal area for passive bony overlap and thickness of buccal and lingual plates for rigid fixation, the most important factors are related to surgical technique. Conclusions: Anterior osteotomy just to the midline of inferior border and horizontal osteotomy to the mandibular foramen are associated with split patterns that result in optimal rigid fixation and passive bony overlap for OSA patients undergoing MMA. Clinical relevance: Optimal surgical technique has the most significant influence in allowing rapid return to function after MMA in patients with OSA. [ABSTRACT FROM AUTHOR]

Objective: To three-dimensionally evaluate post-operative mandibular stability following bilateral sagittal split ramus osteotomies between hybrid and non-hybrid rigid internal fixation techniques., Materials and Method: Seventy adults with skeletal class II deformity who underwent bilateral split sagittal osteotomy with mandibular advancement were included. Patients were divided into four groups based on their fixation techniques: hybrid technique (HT) groups I, II, and IV received a 4-hole 2 mm miniplate with either a bicortical screw (BS), additional 2 mm 4-hole miniplate, or two-hole miniplate, while non-HT group III received a 4-hole 2 mm miniplate with four mini-screws (MS). Measurements were taken pre-operatively (T0), immediately postoperatively (T1), and ≥1 year after surgery (T2) using 3D Slicer software., Results: Age, sex, and follow-up period did not correlate significantly with postoperative relapse or stability. Significant differences were observed in the advancement on the right side between groups II, III, and IV and on the left side between groups I, III, and IV. However, the type of surgical intervention showed no significant effect on postoperative relapse and stability. All groups of fixations showed satisfactory stability with irrelevant relapse (< 2 mm or 2°)., Conclusion: The study demonstrated satisfactory and comparable stability among different fixation groups on patients undergoing mandibular advancement following bilateral split sagittal osteotomy. The results highlighted the importance of considering the degree of advancement when planning orthognathic surgery and managing postoperative outcomes., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest concerning this article's research, authorship, and publication., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Inferior alveolar nerve (IAN) damage is a common complication occurring after sagittal split osteotomy (SSO) and results in sensory disorders of the jaw region. In recent years, published experimental and clinical evidence suggests that low-level laser (LLL) radiation is effective in nerve recovery. Therefore, the aim of the present study was to review clinical trial studies investigating the effect of LLL radiation on improving the sensory defects of IAN after SSO. The keywords associated with SSO and LLL were searched in PubMed, Medline (via Ovid), Web of Science (WOS), Scopus, and Cochrane Library databases. Then, controlled clinical trial studies published before November 2017 regarding LLL radiation conducted on patients with IAN neuropathy due to SSO were investigated. The articles fulfilling the study criteria were further scrutinized and the necessary information was extracted from them. A total of seven papers were included in the study. The diode laser used had a wavelength range of 760-930 nm, radiation power of 20-200 mw, and radiation energy of 10.2-95 J (per point of radiation). In the mentioned studies, the patients underwent 3-20 sessions of laser irradiation and were monitored for an additional 0-23 months after completion of the laser intervention. The tests performed in the mentioned studies dealt with examining the perceptions of superficial touch and pressure, two-point discrimination, stimulus movement on skin, temperature, and pain. Furthermore, the patients' general awareness regarding sensory perception in the mandibular region was gauged. In six studies, laser irradiation caused relative improvement in the IAN sensory disorder for a subjective test as well as for one or more objective tests. In the reviewed clinical trial studies, LLL was generally found to be effective in improving the IAN sensory disturbance resulting from SSO, though there was no placebo effect. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of the application of photobiomodulation in a 2-year follow-up period in patients who have been intervened with a sagittal ramus split osteotomy and present neurosensory disturbance of the inferior alveolar nerve. Background: Photobiomodulation is a common clinical tool in dentistry, for its beneficial effects have been shown in surgical and periodontal wound healing, reducing of swelling and pain, neurosensory recovery, and treatment of temporomandibular joint disorders. Methods: This is a 2-year follow-up study with an experimental (Laser) group ( n = 33) that received photobiomodulation, and a control (Sham) group ( n = 9), placebo. All patients from the Laser group received laser applications (continuous wave of 0.353 W/cm2, 27 J in 270 sec per session) on days 1, 2, 3, 5, 10, 14, 21, and 28 after surgery. Neurosensory disturbance was evaluated with five tests: Visual Analog Scale (VAS) for pain and sensitivity, sensitivity threshold test, two-point discrimination, and thermal discrimination. All tests were performed before (24 h before surgery) and after surgery (24 h, 28 days, 60 days, 6 months, 1 year, 2 years, more than 2 years). Participants and evaluator were blinded to intervention. Variables were described with absolute frequencies, percentages, and medians. Ordinal and dichotomous variables were compared with Mann-Whitney's and Fisher's tests, respectively. Results: Clinical improvement was observed during the follow-up period for the Laser group; general VAS for sensitivity was normal in 11 participants from the Laser group at 2 years postsurgery (40.74%), while no participants from the Sham group achieved this ( p = 0.0341). Twenty-three participants recovered initial values for two-point discrimination (69.7%) after 2 years of follow-up ( p = 0.0025) as well as sensitivity threshold test. General VAS for pain was normal in 31 patients from the Laser group after 2 years of follow-up (93.94%, p = 0.0254). Conclusions: Photobiomodulation was effective for neurosensory recovery on sample studied. [ABSTRACT FROM AUTHOR]