title: Investigation of the influence of mallet and chisel techniques on the lingual fracture line and comparison with the use of splitter and separators during sagittal split osteotomy in cadaveric pig mandibles.
abstract: In bilateral sagittal split osteotomy the proximal and distal segments of the mandible are traditionally separated using chisels. Modern modifications include prying and spreading the segments with splitters. This study investigates the lingual fracture patterns and status of the nerve after sagittal split osteotomy (SSO) using the traditional chisel technique and compares these results with earlier studies using the splitter technique. Lingual fractures after SSO in cadaveric pig mandibles were analysed using a lingual split scale and split scoring system. Iatrogenic damage to the inferior alveolar nerve was assessed. Fractures started through the caudal cortex more frequently in the chisel group. This group showed more posterior lingual fractures, although this difference was not statistically significant. Nerve damage was present in three cases in the chisel group, but was not observed in the splitter group. A trend was apparent, that SSO using the chisel technique instead of the splitter technique resulted in more posterior lingual fracture lines, although this difference was not statistically significant. Both techniques resulted in reliable lingual fracture patterns. Splitting without chisels could prevent nerve damage, therefore we propose a spreading and prying technique with splitter and separators. However, caution should be exercised when extrapolating these results to the clinic.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Jop P
authors.initials: JP
authors.lastname: Verweij
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands; Department of Oral and Maxillofacial Surgery, Amphia Hospital, Breda, The Netherlands.
authors.forename: Gertjan
authors.initials: G
authors.lastname: Mensink
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Pascal N W J
authors.initials: PN
authors.lastname: Houppermans
authors.affiliation: Department of Oral and Maxillofacial Surgery, Utrecht University Medical Center, Utrecht, The Netherlands.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Frank
authors.affiliation: Department of Oral and Maxillofacial Surgery, Leiden University Medical Centre, Leiden, The Netherlands. Electronic address: J.P.R.van_Merkesteyn@lumc.nl.
authors.forename: J P Richard
authors.initials: JP
authors.lastname: van Merkesteyn
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D004867:Equipment Design; D005260:Female; D007049:Iatrogenic Disease; D007431:Intraoperative Complications; D008334:Mandible / Q000294:innervation / Q000601:surgery*; D008340:Mandibular Nerve / Q000033:anatomy & histology; D059229:Osteotomy, Sagittal Split Ramus / Q000295:instrumentation*; D013314:Stress, Mechanical; D013552:Swine; D061221:Trigeminal Nerve Injuries / Q000209:etiology
keywords: Fracture pattern; Inferior alveolar nerve; Lingual fracture; Mandibular osteotomy; Nerve damage; Sagittal split osteotomy