title: Complications of bicortical screw fixation observed in 482 mandibular sagittal osteotomies.
abstract: Bicortical screw fixation after bilateral sagittal split osteotomy (BSSO) of the mandible is commonly used in orthognathic surgery and allows many advantages compared with osteosynthesis wires and maxillomandibular fixation. Complications include early loosening, hardware exposition, skeletal instability or early relapses, persistent nerve impairments, infection, and scar formation. This article is based on a retrospective analysis of complications of bicortical screw fixation observed in 241 consecutive patients with dento-skeletal Class III, corresponding to 482 sides, during the immediate postoperative period and at 1, 3, 6, and 12 months' follow-up. In the immediate postoperative period, poor stability of fixation caused by screw loosening was observed in 3 of 482 (0.62%) sides; at the 1-month follow-up, infections were encountered in 12 (2.48%) sides at mandibular angles. Additional complications were not seen in the series. Stability of fixation was found in the 482 sides at 12 months. However, complications directly related to bicortical screws were observed in 15 sides or 3.11%. Age and gender of patients were not correlated with the incidence of complications. Assiduous follow-up during the early postoperative period and 1 and 2 months after surgery is recommended in patients with bicortical screw fixation after BSSO to verify adequate oral hygiene and provide early observation of the onset of any infections, skeletal instabilities, or relapses.
authors.affiliation: Department of Maxillofacial Surgery, University La Sapienza, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Becelli
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Fini
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Renzi
authors.forename: Filippo
authors.initials: F
authors.lastname: Giovannetti
authors.forename: Emiliano
authors.initials: E
authors.lastname: Roefaro
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D019248:Jaw Fixation Techniques / Q000009:adverse effects* / Q000295:instrumentation*; D061222:Lingual Nerve Injuries; D008297:Male; D008313:Malocclusion, Angle Class III / Q000601:surgery*; D008334:Mandible / Q000601:surgery*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D061221:Trigeminal Nerve Injuries