Modified bilateral sagittal split osteotomy for correction of severe anterior open bite: Technical note and case report

Abstract

Bilateral sagittal split osteotomy (BSSO) is a common procedure used for the correction of mandibular anomalies. This procedure has been through various modifications that aims to increase skeletal stability and reduce possible complications. So far, the limitation of BSSO technique remains a concern in certain circumstances, such as skeletal relapse after closing of anterior open bite, especially in severe cases. Also, there is a risk of facial paralysis following a large amount of mandibular setback in a severe mandibular prognathism. Therefore, concomitant surgery such as segmented osteotomy and/or maxillary osteotomy may be used for correction of the deformity in order to avoid those specific complications. This article proposes a new alteration of BSSO technique (Prasan’s modification) that provides an ease of mandibular counterclockwise rotation. This method also allows the mandible to be set backward to a large extent. The modification of posterior osteotomy makes this technique simpler than the existing BSSO methods. For example, a satisfactory result after using this technique was demonstrated in this case report of a patient with severe anterior open bite in combination with sever mandibular prognathism. Likewise, this method has also enabled the advancement of the mandible. Hence, it can be applied as another alternative procedure for correction of mandibular anomalies.