Poster Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

Preserve the nerve – incorporating advanced technology to improve the safety and reliability of the bilateral sagittal split osteotomy in corrective mandibular surgery (1429)

Alistair McCombe 1 , Anthony Reynolds 1 , Fraser Donaldson 1 , Tasciana Gordon 1 , Brian Finn 1
  1. Cairns Hospital, Cairns, QLD, Australia

The bilateral sagittal split osteotomy (BSSO) is a common procedure used to correct deformities of the mandible. Since its inception in the 1950s, the BSSO has undergone many modifications and adjustments that were developed in order to improve the predictability of the bone split, as well as to reduce the complication of damage to the inferior alveolar nerve (IAN). Our method begins with pre-operative fine-slice CT to virtually plan the surgery, as well as to delineate precise course of the patients’ mandibular canals as studies have shown these to be highly variable. Custom-made 3D-printed cutting guides and osteosynthesis plates are carefully designed to maximise surgical safety and efficiency, as well as to minimise human error. Predictive hole positioning adds to surgical efficiency and reliable results. Computer-aided design (CAD) and computer-aided manufacturing (CAM) technology are not new to the field of orthognathic surgery. However, we have reviewed other modifications to the BSSO published recently, and believe that this method we describe holds a uniquely reliable, advanced and safe place among them, achieving predictable splits whilst significantly reducing the risk of damage to the IAN. We anticipate that this and similar methods and technology will become gold standard in the future for these procedures.  We do emphasise that surgical skill and knowledge must be maintained so that unexpected changes to the virtual plan can be dealt with in theatre.

Download Presentation