Bilateral Sagittal Spilt Osteotomy and Genioplasty in Patient with Lymphatic Malformation

Video Type: CVideo
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Author: Aaron Smith
Published:
Specialties: Oral Maxillofacial, Otolaryngology, Pediatric Otolaryngology, Plastic Surgery
Schools: University of Arkansas for Medical Sciences
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Basic Info

Contributors: Michael Golinko, MD,  John Jones, MD, DMD,  Kumar Patel, PA

Bilateral sagittal split osteotomy and genioplasty in 5y/o girl with lymphatic malformation.

DOI#: https://doi.org/10.17797/hlo056ep2r

Advanced

Procedure

Bilateral Sagittal Spilt Osteotomy and Genioplasty

Indications

horizontal mandibular excess or asymmetry, need for mandibular advancement

Contraindications

co-morbidities increasing surgical risk

Instrumentation

Setup

supine, nasal intubation, general anesthesia, Inferior alveolar nerve block

Preoperative Workup

Dental impressions, 3D CT, photos, collected; precise cuts planned and post-operative appearance simulated; Post-op chin strap constructed. History & Physical Exam, CBC, Coagulation Profile, CMP, ASA Classification

Anatomy and Landmarks

With intra-oral incision, watch for 'dimple' of Stensen's duct in the region of the 2nd maxillary molar. Mucosa is incised at anterior border of the ramus, exposing the external oblique ridge, from the coronoid notch to the second molar. Reciprocating saw passed down the oblique ridge, approximately to the level of the 2nd molar, and then vertically down the inferior mandibular border. For genioplasty note course of the inferior alveolar nerve exiting the mental foramen usually ~ 5mm below this foramen between the 1st and 2nd pre-molars.

Advantages/Disadvantages

Correction of anterior open bite, better oral competence, positive aesthetic outcome. Operative risk and risk of post-op infection or regression.

Complications/Risks

bleeding following injury to the masseteric or inferior alveolar artery, unanticipated splits/fractures, witches-chin deformity from improper mentalis muscle suspension, damage to Inferior alveolar or mental nerve

Disclosure of Conflicts

bleeding following injury to the masseteric or inferior alveolar artery, unanticipated splits/fractures, witches-chin deformity from improper mentalis muscle suspension, damage to Inferior alveolar or mental nerve

Acknowledgements

References

Bilateral Sagittal Split Osteotomy, Laura A. Monson, MD. Semin Plast Surg. 2013 Aug; 27, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805998/

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