title: Mandibular Sagittal Split Osteotomy for Removal of Impacted Mandibular Teeth: Indications, Surgical Pitfalls, and Final Outcome.
abstract: OBJECTIVE
  The purpose of this study was to determine the indications for mandibular sagittal split osteotomy (MSSO) for the removal of impacted mandibular teeth and to evaluate the surgical pitfalls and final outcomes.
  
  
  METHODS
  In this retrospective case-series study, radiologic and clinical data of all patients who underwent MSSO for the removal of impacted mandibular teeth between 2008 and 2015 at the University Hospitals of Geneva were reviewed. The primary outcome variables were 1) the indication for the removal of impacted mandibular teeth by MSSO, 2) complications, and 3) surgical pitfalls. Other variables included age, gender, teeth involved, indication for tooth removal, concomitant lesions such as cysts and/or tumors, and radiologic features.
  
  
  RESULTS
  In 18 consecutive patients, 21 impacted mandibular teeth (18 third molars, 2 second molars, and 1 first molar) were extracted by MSSO. In all patients the indication for the MSSO approach included deeply impacted teeth associated with an intimate relationship between the inferior alveolar nerve and the dental roots as shown on computed tomography or cone-beam computed tomography scan images. A non-disabling hypoesthesia of the inferior alveolar nerve developed in 6 patients (33.3%). Major complications occurred in 3 patients (16.6%), including 2 cases of infection (11.1%) and 1 case of a "bad split" (5.5%).
  
  
  CONCLUSIONS
  This study showed that the MSSO approach is a valuable method for removing deeply impacted teeth in proximity to the mandibular canal. Local factors, such as bone remodeling, concomitant large lesions (cysts and/or tumors), and the mandibular canal within the buccal cortex, represent pitfalls that might increase the risk of complications developing.
authors.affiliation: Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Zulma
authors.initials: Z
authors.lastname: Catherine
authors.affiliation: Head, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland. Electronic address: paolo.scolozzi@hcuge.ch.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scolozzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery*; D008875:Middle Aged; D059229:Osteotomy, Sagittal Split Ramus / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000379:methods*; D014095:Tooth, Impacted / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult