What is Bilateral Sagittal Split Osteotomy?

BSSO is a procedure used to correct misalignment of the mandible (lower jaw). It involves surgically splitting the lower jaw on both sides and moving it either forward or backward. This adjustment helps in achieving a more balanced bite and improves facial symmetry.

Reasons for the Procedure

Patients might consider a BSSO for several reasons, including:

• Malocclusion: Where teeth do not fit together correctly due to jaw misalignment.
• Prognathism: An extended lower jaw.
• Retrognathism: A receded lower jaw.
• Aesthetic Concerns: Desire to improve facial profile and symmetry.
• Functional Issues: Difficulties in chewing, speaking, and breathing.

Pre-Surgical Preparation

• Initial Consultation: Involves detailed imaging (X-rays, 3D scans) to plan the surgery.
• Physical Examination: Assessing overall health to ensure fitness for surgery.
• Dental Preparation: May include orthodontic braces to align the teeth before surgery.
• Pre-surgical Guidelines: Instructions on eating, drinking, and medication adjustments before surgery.

The Surgical Procedure

• Anesthesia: Performed under general anesthesia.
• Surgical Steps:
  1. An incision is made inside the mouth to expose the jawbone.
  2. Specialized surgical instruments are used to make a horizontal cut on each side of the lower jaw.
  3. The lower jaw is carefully split and moved into the new position.
  4. The new position of the jaw is secured using screws and metal plates.
  5. The incisions are sutured closed.
• Duration: The surgery usually takes several hours.

Post-Surgical Care

• Hospital Stay: Usually requires a hospital stay of 1-2 days.
• Pain Management: Pain and swelling are managed with medications.
• Diet: A liquid or soft diet is necessary for a few weeks post-surgery.
• Oral Hygiene: Special instructions will be given for oral care to avoid infection.
• Activity: Limited activity is recommended in the initial recovery phase.

Recovery and Follow-Up

• Immediate Recovery: Involves managing swelling and discomfort.
• Follow-Up Visits: Regular visits are necessary to monitor healing and remove any non-dissolvable sutures.
• Long-Term Care: Final alignment may involve further orthodontic treatment to fine-tune the bite.

Risks and Complications

As with any surgery, BSSO carries potential risks:

• Infection
• Nerve damage leading to temporary or permanent numbness
• Relapse of the jaw position
• Problems with jaw function
• Need for revision surgery

Expected Outcomes

• Improved Jaw Function: Better alignment improves chewing and speaking.
• Aesthetic Benefits: Enhances facial symmetry and profile.
• Improved Dental Health: Correct alignment reduces wear and tear on teeth.

Conclusion

Bilateral Sagittal Split Osteotomy is a significant surgical intervention used to correct jaw misalignment with both functional and aesthetic benefits. Patients considering this procedure should discuss thoroughly with an experienced oral and maxillofacial surgeon to understand all aspects, including the risks, benefits, and the commitment required for post-surgical care and recovery.

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