Mandibular Basal Osteotomy: New Designs and Fixation Techniques

• Published in: Journal of oral and maxillofacial surgery Vol. 69; no. 3; pp. 786 - 797
• Main Authors: Lopez, Patricia E., DDS, Guerrero, Cesar A., DDS, Mujica, Elena V., DDS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2011
• Subjects: Adult; Chin - pathology; Chin - surgery; Dentistry; Facial Asymmetry - surgery; Facial Nerve Injuries - prevention & control; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional - methods; Jaw Fixation Techniques - instrumentation; Male; Mandible - pathology; Mandible - surgery; Mandibular Diseases - surgery; Mandibular Nerve - anatomy & histology; Middle Aged; Orthognathic Surgical Procedures - methods; Osteotomy, Le Fort - methods; Retrospective Studies; Statistics, Nonparametric; Surgery; Tomography, X-Ray Computed; Young Adult
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2010.11.038

Purpose This study evaluated the functional and cosmetic results of mandibular basal osteotomy, introducing new indications and fixation alternatives. Materials and Methods Ten patients 19 to 46 years old (mean, 32.3 years) were treated by orthognathic surgery, including mandibular basal osteotomy for correction of deficiency, excess, or asymmetry of the inferior mandibular border. An intraoral approach based on 3 incisions to the anterior and posterior mandible was used to maintain and protect soft tissues surrounding the mental nerve. After marking the bone inferior to the nerve, a reciprocal saw completed the osteotomy design and individual rigid fixation according to movement was executed. All patients were 3-dimensionally treated and the evaluation included clinical, radiographic, and photographic analysis pre and postoperatively; all patients were followed for a minimum of 12 months. Results All patients showed excellent functional and cosmetic results. Nine patients (9/10) were treated for advancement of the inferior border (mean, 6.89 ± 2.57 mm; P < .05). One of them underwent simultaneous inferior (3 mm) and lateral (4 mm) repositioning and 3 had combined lateral movement (mean, 3.5 ± 0.58 mm; P < .05). One patient (1/10) required posterior (4 mm) and inferior (5 mm) repositioning of the basal segment. Conclusions Mandibular basal osteotomy is an innovative technique that is strongly predictable for correction of deficiency, excess, and/or asymmetry of the inferior mandibular border, decreasing morbidity and many other complications of traditional bone grafts and alloplastic techniques.