A retrospective study of unfavorable fractures during sagittal split osteotomy: A single surgeon’s experience

Background

Unfavorable fractures are among the most common complications of bilateral sagittal split ramus osteotomy (BSSRO). This study aimed to evaluate unfavorable fracture patterns during BSSRO and assess the related risk factors and treatment measures.

Methods

The clinical records and radiographs of 679 patients (1 358 sides) who underwent BSSRO at Shanghai Ninth People’s Hospital between September 2013 and December 2021 were examined.

Results

Patients with unfavorable fractures who underwent surgical restoration were studied. The incidence of unfavorable fractures was 0.8% (n=11), with the highest rate in the third year. The unfavorable fractures were divided into three types by location and clinical treatment: (1) SSRO could still be completed after buccal/lingual plate unfavorable fracture (0.6%, n=8); (2) condylar/coronoid process fractures/intermaxillary fixation needed (0.1%, n=2); (3) additional osteotomy required (0.07%, n=1).

Conclusion

These results suggest that as a surgeon’s experience increases, the rate of unfavorable fractures may decrease. The novel classification of unfavorable fractures for SSRO might be useful for surgeons to make appropriate treatment choices during orthognathic surgery.