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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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Stability and Bifurcation of a Cholera Epidemic Model with Saturated Recovery Rate
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Tue Oct 09 2018
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Bulletin Of The Iraq Natural History Museum (p-issn: 1017-8678 , E-issn: 2311-9799)
OUTSTANDING UNIVERSAL VALUES OF THE SAWA LAKE AS A WORLD NATURAL HERITAGE
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Thu Mar 30 2023
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College Of Islamic Sciences
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The effect of pedestrian roads in providing a comfortable environment for humans
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Wed Jun 28 2023
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Abstract<p>Iraq, home of the Tigris and Euphrates rivers, has survived an extreme deficiency of surface water assets over the years. The gap is due to the decline of the Iraqi water share every year, as well as a high demand for water use from different sectors, particularly agriculture.</p><p>Dam development has long given significant economic benefits to Iraq in circulating low‐priced electricity and supporting low‐income farmers by supplying them with a free irrigation system (Zakaria et al, 2012). This encouraged domestic consumption and investment.</p><p>Despite the fact that numerous advantages are expected from dam construction, it should be painstakingly assessed, utilizing cost</p> ... Show More
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