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Partial Bone Necrosis Following Sagittal Split Ramus Osteotomy: Report of a Complicated Orthognathic Jaw Surgery
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Study Design

Case Report.

Objective

To present a case of a previous complicated mandibular orthognathic surgery that aimed to setback the mandible in a female cleft lip and palate (CLP) patient, which led to bone necrosis on one side with subsequent severe mandibular deviation and facial asymmetry. We additionally reviewed the previous reports of similar complications, the pathophysiology and the factors that could lead to this dreadful result.

Method

A 27-year-old female patient presented with a severe dentofacial deformity secondary to a complicated bilateral sagittal split ramus osteotomy performed five years earlier, which resulted in aseptic bone necrosis on the right side. The patient had marked mandibular deviation, chin and midface retrusion and a pronounced occlusal discrepancy. Imaging demonstrated a bony defect at the right mandibular angle with a superiorly displaced proximal segment. Deviation of the mandible was corrected first by performing vertical ramus subsigmoid osteotomy (RSO) on the left side. The right bone defect was then reconstructed with a reconstruction plate and bone grafting. Maxillary and chin advancement was performed at a second stage.

Results

On follow-up, the patient shows a significant improvement in facial esthetics and mandibular symmetry and is currently under orthodontic management to enhance the occlusal relationship.

Conclusion

Bone necrosis is a rare but dreaded problem in orthognathic surgery. Minimizing the musculo-periosteal dissection and competent execution of the bone osteotomy is substantially effective in reducing the risk of bone ischemia and necrosis.

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Publication Date
Thu Jun 15 2023
Journal Name
Journal Of Craniofacial Surgery
Evaluation of the Lingual Splitting Patterns and the Lateral Bone Cut Ends Following Mandibular Bilateral Sagittal Split Osteotomy Using Cone Beam Computed Tomography (CBCT)
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The bilateral sagittal split osteotomy (BSSO) is the most popular orthognathic procedure performed by maxillofacial surgeons to treat skeletal class II and class III and to correct mandibular asymmetries. The study aimed to evaluate the lingual splitting patterns and lateral bone cut end (LBCE) in bilateral sagittal split osteotomy (BSSO) and their relation with the ramal thickness and the presence of impacted third molars using cone beam computed tomography (CBCT). This prospective observational study included patients with mandibular prognathism who were treated with BSSO with or without Le Fort I osteotomy. Cone beam computed tomography was used to measure the ramal thickness preoperatively and to evaluate the LBCE, and the lingu

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Publication Date
Thu Dec 19 2024
Journal Name
Journal Of Baghdad College Of Dentistry
Computed tomography bone density in Hounsfield units at dental implant receiving sites in different regions of the jaw bone
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Background: Determination of local bone mineral density (BMD) with cortical thickness and bone height may offer a comprehensive description of the bone the surgeon will encounter when he or she actually sets the implant. Quantitative computed tomography (CT) (i.e., quantitative interpretation of values derived from Hounsfield units with a suitable calibration procedure) is the modality of choice to determine BMD. The aim of the present clinical study is to determine the local bone density in dental implant recipient sites using computerized tomography. Material and method: The sample consisted of (72) Iraqi patients whom referred to Al-Kharkh General hospital, Spiral CT scan Department for bone quality and quantity assessment after one wee

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Publication Date
Sun Apr 02 2006
Journal Name
Journal Of The Faculty Of Medicine Baghdad
pancreatic fistula following surgery of primary pancreatic hydatid cyst causing pancreatitis
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Background:

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Crossref
Publication Date
Sun Dec 07 2014
Journal Name
Baghdad Science Journal
Study the Changes of Thyroid Hormones Levels Following Major Urological Surgery
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This study was designed to evaluate the effect of major surgery on thyroid hormones and thyrotropin in patient undergoing major lower abdominal surgery. The study included fifty patients scheduled for elective major lower abdominal surgery, the serum levels of T3, T4 and TSH were determined one day preoperatively, intraoperative, one day postoperatively, two days postoperatively, and rT3 was determined one day preoperatively, and one day postoperatively. We observed that the levels of (T3, T4, TSH) increased significantly (P<0.05) intraoperatively, one day postoperatively the levels of T3 and T4 reduced significantly (P<0.05), while TSH reduced not significantly (P>0.05), and two days postoperatively T4 and TSH returned to increase si

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Publication Date
Thu Dec 19 2024
Journal Name
Journal Of Baghdad College Of Dentistry
Factors associated with facial swelling severity following impacted lower third molar surgery: A prospective study
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Background: The ultimate purpose of this prospective study is to estimate and measure swelling associated with surgical extrac¬tion of impacted mandibular third molars in different four post-operative times and to identify the risk factors associated with determination of their risk degree. Material and Methods: In this prospective cohort study 159 consecutive cases in which removal of impacted lower third molars in 107outpatients were evaluated. Five groups of variables have been studied which are regarded as a potential factor for swelling after mandibular third removal which will enable the surgeon to predict and counsel high risk patients in order to offer a preventive strategy. Results: Facial measurements were carried out on 1st, 2

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Publication Date
Thu Aug 24 2017
Journal Name
Clinical Case Reports
Primary hypogonadism, partial alopecia, and Müllerian hypoplasia: report of a fifth family and review
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Key Clinical Message<p>Primary hypogonadism combined with Müllerian hypoplasia and partial alopecia are common features of this syndrome, which was reported only in four earlier families from areas where consanguineous marriage is prevalent. An autosomal recessive pattern of inheritance was suggested earlier and is supported by this report.</p>
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Publication Date
Thu Nov 01 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Effect of Nursing Educational Program on Recovery Following CABG Surgery: Intervention Study
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This intervention study is composed on 55 patients at Saddam Center for Cardiac Surgery (Aben-Albetar) throughout the period from 1st of July 1997 to 15th of January 1999. The study aimed to evaluate the effectiveness of constructed nursing education program on reduction of complications and improving recovery among patients with Coronary Artery Bypass Graft (CABG) surgery through the application of repeated measures. The sample is divided into 27 patients who received the nursing educational program (study group) and 28 patients who continued to receive regular care (controls). Based on previous research meth

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Publication Date
Sun Dec 03 2017
Journal Name
Baghdad Science Journal
The Effect of Anesthesia on Thyroid Hormones and Cortisol Levels Following Major Urological Surgery
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This study was designed to evaluate the effect of anesthesia on thyroid hormones (T3, T4, rT3), thyrotropin(TSH), and cortisol levels in patients undergoing major urological surgery. The study included fifty patients scheduled for elective major urological surgery where 70% of the patients underwent general anesthesia, while30% underwent regional anesthesia. All patients were in stable control general conditions. The study showed that the thyroid hormones, thyrotropin and cortisol levels were affected with general anesthesia more than regional. The levels of these hormones responded to anesthetics and surgical stresses. This response was thought to be mainly mediated by afferent neurogenic impulses from the area of injury. Therefore, ab

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Publication Date
Fri Dec 31 2021
Journal Name
Dental And Medical Problems
Effect of the local application of bupivacaine in early pain control following impacted mandibular third molar surgery: A randomized controlled study
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Background: Postoperative pain is one of the main complications following impacted mandibular third molar (IMTM) surgery. Objectives: The aim of this study was to assess the effect of the local application of bupivacaine on reducing early postoperative pain following IMTM surgery. Material and methods: A prospective, single-blinded, randomized controlled study was conducted on 40 patients who had undergone the surgical removal of an IMTM under local anesthesia. In the study group (n = 20), absorbable gelatin sponge (AGS) soaked in 3 mL of 0.5% plain bupivacaine hydrochloride was locally applied in the post-extraction socket. In the control group (n = 20), AGS soaked in 3 mL of normal saline was used. Pain intensity was assessed using a pa

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Publication Date
Thu Jan 30 2014
Journal Name
Al-kindy College Medical Journal
Managementt o f non traumatic A vascular Necrosis off Femoral Head at precollapse stage with Core Decompression and tibial Bone Grafting
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 Avascular necrosis have always presented great challenges to orthopedic surgeons and patients, remain in many ways today the unsolved dilemma. Varieties of non-vascularized bone grafting techniques preceded by core decompression have been proposed with varying degrees of success. O bb j ee cc t i vv ee ss : The aim of this study is to review the the value of core decompression and non-vascularized tibial bone strip graft treatment for early stages of non-traumatic osteonecrosis stage II & III according to stein burg staging . M ee t hh oo dd ss : prospectively reviewed 26 patients (32 hips) with osteonecrosis of the femoral head between June 2006 and December 2013 at Imam Ali hospital in Sader city & Al-Wasity teaching hosp

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