Skeletal stability and complications of bilateral sagittal split osteotomies and mandibular distraction osteogenesis: an evidence-based review.
OBJECTIVE
To provide an evidence-based review comparing the skeletal stability and complications of bilateral sagittal split osteotomies (BSSOs) and mandibular distraction osteogenesis (MDO) in the treatment of mandibular hypoplasia.


METHODS
A Medline search from January 1957 to December 2007 was performed wherein articles were retrieved on the basis of a set of inclusion and exclusion criteria. Data on mean skeletal stability and complications for the 2 techniques were retrieved from these articles.


RESULTS
Based on the articles about stability, patients undergoing BSSO or MDO with an advancement or lengthening between 6 and 10 mm showed a similar mean skeletal relapse of 15.0% and 17.1%, respectively, within postoperative months 6 to 12. Greater skeletal relapse was reported for BSSO patients with high mandibular plane angles compared with normal mandibular plane angle patients (29.6% vs 11.3%). Based on the articles about complications, patients who underwent MDO showed a lower incidence of persistent inferior alveolar nerve disturbance (2.9%) and condylar resorption (1.4%) compared with BSSO patients, in whom the incidence of these conditions was 27.8% and 6.1%, respectively.


CONCLUSIONS
Both BSSO and MDO showed similar relapse rates for mandibular advancements between 6 and 10 mm. Both techniques may also share similar risk factors for skeletal relapse. BSSO has a higher incidence of persistent neurosensory disturbances and condylar resorption than MDO. Randomized controlled trials of these 2 techniques are still lacking.
Ow
Andrew
A
Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Prince Philip Dental Hospital, Hong Kong Special Administrative Region.
Cheung
Lim Kwong
LK
D000293:Adolescent; D000328:Adult; D002648:Child; D055094:Evidence-Based Dentistry; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000002:abnormalities / Q000254:growth & development / Q000601:surgery*; D019186:Mandibular Advancement / Q000009:adverse effects / Q000379:methods*; D008844:Micrognathism / Q000601:surgery*; D019647:Oral Surgical Procedures / Q000379:methods; D019857:Osteogenesis, Distraction / Q000009:adverse effects / Q000379:methods*; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000145:classification / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult