The features of bad splits in Bilateral Sagittal Split Osteotomy (BSSO) of the mandible and the intuitive classification and possible clinical management: A literature review.

Abstract

The current literature review aims to locate articles that describe the causes and risk factors of bad splits during BSSO as well as the most intuitive categorizations and appropriate clinical management. In August 2022, an electronic search of the literature from 2000 to 2022 was completed using the Google Scholar and PubMed websites. Based on these results, 42 publications were reviewed in order to comprehend the aetiology of bad splits, how they should be classified, and how they should be managed during BSSO operations. The most common causes of bad splits are age, gender, third molars (presence or absence) , variation in buccolingual measurements of the ramus and retromolar region of the mandible, expertise and dexterity of the surgeon in relation to the BSSO approaches and instrumentation. Many authors such as Teltzrow et al., Plooij et al., Muto et al., and Jiang et al. have provided multiple classifications , Whereas, Jiang et al.'s classification is the intuitive one that can classify the bad splits because it is based on clinical management. Surgeons often use an osteosynthetic plate and microplate in combination with a bicortical or monocortical screw, with or without IMF , to repair unfavourable fractures.