J Korean Assoc Oral Maxillofac Surg.  2023 Jun;49(3):107-113. 10.5125/jkaoms.2023.49.3.107.

Mandibular midline osteotomy for correction of bimaxillary transverse discrepancy: a technical note

• Ramanathan M
• Sonoyama-Osako R
• Shimamura Y
• Okui T
• Kanno T

• KMID: 2544312
• DOI: http://doi.org/10.5125/jkaoms.2023.49.3.107

Abstract

Bimaxillary transverse width discrepancies are commonly encountered among patients with dentofacial deformities. Skeletal discrepancies should be diagnosed and managed appropriately with possible surgical corrections. Transverse width deficiencies can present in varieties of combinations involving the maxilla and mandible. We observed that in a significant proportion of cases, the maxilla is normal, and the mandible showed deficiency in the transverse dimension after pre-surgical orthodontics. We designed novel osteotomy techniques to enhance mandibular transverse width correction, as well as simultaneous genioplasty. Chin repositioning along any plane is applicable concomitant with mandibular midline arch widening. When there is a requirement for larger widening, gonial angle reduction may be necessary. This technical note focuses on key points in management of patients with transversely deficient mandible and the factors affecting the outcome and stability. Further research on the maximum amount of stable widening will be conducted. We believe that developing evidence-based additional modifications to existing conventional surgical procedures can aid precise correction of complex dentofacial deformities.

Keyword

Orthognathic surgery; Mandibular osteotomy; Maxillary osteotomy; Transverse correction

Figure

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  Fig. 1 Preoperative virtual planning with Proplan CMF software (Materialise). A. Mandibular midline widening with advancement genioplasty, frontal and right lateral profile views. B. Mandibular midline widening with reduction genioplasty, frontal and left lateral profile views. C. Mandibular midline widening preserving genial morphology, frontal and lateral profile views.

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  Fig. 2 Fig.2. Intra- and postoperative photos of mandibular midline widening with advancement genioplasty 46-year-old female patient with apertognathia and asymmetry. Our treatment plan consisted of Le Fort I osteotomy with impaction (4 mm), bilateral sagittal split ramus osteotomy setback (7 mm) with advancement genioplasty (4 mm) and 3 mm midline mandibular widening at first molar. A. Positioning of saw to perform the midline cut. B. Completion of osteotomy cut. C, D. Separation and mobilization of osteotomized segments. E. Stabilizing the fragments with interocclusal splint. F. Bioresorbable osteosynthesis placement. G. Postoperative three-dimensional computed tomography demonstrating skeletal changes, frontal and profile views.

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  Fig. 3 Intra- and postoperative photos of mandibular midline widening with reduction genioplasty 17-year-old female patient with Class III dentofacial profile and asymmetry. Our treatment protocol consisted of Le Fort I osteotomy with advancement (4 mm), bilateral sagittal split ramus osteotomy setback (right 3 mm and left 6 mm) with reduction genioplasty (4 mm) and 2.5 mm midline mandibular widening at first molar. A. Osteotomy for reduction genioplasty. B. Removal of intervening bone. C. Completed midline osteotomy cut. D. Separation and fragment mobilization with subsequent splint placement. E. Bioresorbable osteosynthesis placement. F. Postoperative three-dimensional computed tomography demonstrating skeletal changes, frontal and profile views.

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  Fig. 4 Intra- and postoperative photos of mandibular midline widening with preserving genial morphology 19-year-old male patient with Class III malocclusion and dentofacial deformity. Our treatment plan was Le Fort I osteotomy with advancement (3 mm), bilateral sagittal split ramus osteotomy setback (right 4 mm and left 6 mm) with genial osteotomy and 4.5 mm midline mandibular widening at first molar. A. Completed osteosynthesis with bioresorbable plates and screws. B. Ostectomy of gonial angles. C. Postoperative three-dimensional computed tomography demonstrating skeletal changes, frontal and profile views.

Reference

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