Proximal segment positioning in bilateral sagittal split osteotomy: intraoperative controlled positioning by a positioning splint¹

Abstract 

Purpose:

Most techniques of proximal segment positioning hinder intraoperative condyle displacement. However, merely maintaining condylar position cannot optimize the preoperative condyle-disc-fossa relationship. This study attempts to optimize condylar position in the osteotomy patient.

Patients and Methods:

A study group of 23 bimaxillary operated patients had intraoperative joint positioning by positioning splint and plates (9 Angle Class II, 14 Class III). After assessing the habitual and appraising the optimized condyle position on preoperative sonograms and magnetic resonance images, positioning splints were constructed as acrylic occlusal wafers in a semi-individual articulator. Set in occlusion before adaptation of positioning plates, they were intended to move the condyles into the calculated position. Eighteen bimaxillary operated control patients had conventional plate positioning according to the habitual occlusion (9 Angle Class II, 9 Class III). Clinical follow-up, axiography, or sonography was maintained for 24 months. Preoperative lateral cephalograms were scrutinized for horizontal and vertical joint spaces and compared with the immediate postoperative radiography.

Results:

Postoperative Class II study group patients had less dorsal and more vertical joint space and Class III patients more dorsal and vertical space compared with the controls. The study group exhibited significantly less postoperative dysfunction compared with the control group (2-way analysis of variance: P < .021, F = 9.2, α = .05 significance level), disc dislocation prevalence was lower (P < .07, F = 9.2), postoperative changes in condylar translation were smaller (P < .014, F = 4.9), and 8% skeletal relapses versus 22% in the controls were seen.

Conclusions:

A proximal segment-positioning splint effectively positioned the condyle in the desired direction, but with considerable relapse, significantly reduced postoperative dysfunction, disc dislocations, changes to the condylar translation, and incidence of skeletal relapse at 24-month follow-up.

• 1 Received from Maxillofacial and Plastic Facial Surgery, J. W. Goethe University Medical Center, Frankfurt, Germany.