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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
Tue Sep 08 2020
Journal Name
Al-kindy College Medical Journal
Comparison between the Use of bupivacaine 0.5%alone and bupivacaine 0.5% with nefopam 20mg in sciatic n block ( popliteal approach) and femoral n block in patients undergoing below knee surgery
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Objective : Sciatic nerve block (popliteal approach) and femoral N block is a new technique other than general anesthesia in below knee surgery because it provides adequate muscle relaxation, with good intraoperative and post-operative analgesia. Nefopam is non opioid, non-respiratory depressant and non-sedative was mixed with local anesthetics drug to study the effects. This study was done to compare the onset and duration of sensory and onset time and duration of action of motor block following administration of either bupivacaine alone with administration of bupivacaine and Nefopam in patients undergoing below knee lower limb surgeries under ultrasound guided regional anesthesia.
Methods: 100 patients with American society of anest

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Crossref
Publication Date
Thu Mar 09 2017
Journal Name
Ibn Al-haitham Journal For Pure And Applied Sciences
The Synergistic Effect of Zinc, Coumestrol, Genestein and Daidzein on Proinflammatory Cytokines Production and Receptor Activator of NFκB Ligand Expression that Implicates in Bone Resorption
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Several observations have showed the synergistic effect of nutrients elements and phytoestrogens on bone resorption elimination. Zn is one of the trace elements found to increase the stimulatory effect of phytoestrogens including genestein, coumestrol and daidzein on bone formation; however the synergistic modulation of Zn, genestein, coumestrol and daidzein on proinflammatory-producing T-cells and receptor  activator of NFκB ligand (RANKL) expression that implicated in osteoclast formation is still open area to debate. This study found that Zn enhanced the inhibitory effect of genistein, daidzein and coumestrol on TNF-α expression; however the same effect was shown with daidzein on IL-1β expression while there is no furthe

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Publication Date
Sun Jun 22 2025
Journal Name
Journal Of Baghdad College Of Dentistry
The effect of autologous bone marrow-derived stem cells with estimation of molecular events on tooth socket healing in diabetic rabbits (Histological and histomorphometric study)
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Background: Diabetes is a metabolic disorder characterized by chronic hyperglycemia due to an inability to produce insulin. Uncontrolled or poorly controlled diabetes is clinically associated with increased susceptibility to delay healing. Many recent researches have shown that stem cell therapy can be the best choice for treatment of this disease. The aims of this research were investigating regeneration of pancreatic beta cells of diabetic induced rabbits after stem cell transplantation. Materials and Methods: 64 rabbits weighting an average of (2.5 - 3 kg) were used in this experimental study, and divided into 4 groups as follows; group A ( contains 16 healthy rabbits regarded as control group ) , Group B ( contains 16 diabetic rabbits

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Publication Date
Fri Sep 02 2022
Journal Name
Rawal Medical Journal
Comminuted intra-articular distal radius fractures treated by ligamentotaxis external fixation with and without bone marrow injection to prevent late metaphyseal collapse
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Objective: To compare the radiological and functional outcomes of patients of Comminuted intraarticular distal radius fractures treated with or without bone marrow injection along with external fixator ligamentotaxis. Methodology: This prospective comparative study on 41 patients with comminuted intra-articular lower end radius fractures distributed patients randomly into two groups depending on whether an aspirate of bone marrow was injected at the fracture site two weeks after fracture management with external fixation ligamentotaxis. Results: The mean age was 35.8 years, with male predominance. The radiological parameters (radial height, radial inclination, and volar tilt) at the 6th month follow up were lower in the group who did not re

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Scopus
Publication Date
Wed Oct 17 2018
Journal Name
Journal Of Economics And Administrative Sciences
The use of the Principal components and Partial least squares methods to estimate the parameters of the logistic regression model in the case of linear multiplication problem
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Abstract

  The logistic regression model is one of the nonlinear models that aims at obtaining highly efficient capabilities, It also the researcher an idea of the effect of the explanatory variable on the binary response variable.                                                                                  &nb

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Publication Date
Wed Dec 29 2021
Journal Name
Modern Sport
Effect of rehabilitation exercises in improving the motor range of people with partial rupture of the anterior cruciate ligament of the knee joint by ages (30-35) men
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The study aimed to prepare rehabilitation exercises using some rubber ropes for people with partial rupture of the anterior cruciate ligament, to recognize their effect on the recovery of motor tides and to reduce the pain of those with partial rupture of the anterior cruciate ligament of the knee joint, and adopted the experimental method by designing the experimental and controlled groups on a sample of those with partial rupture of the anterior cruciate ligament of men (30-35) One year of those who attend the Physiotherapy Center/Rafidain University College of 12 injured were deliberately selected from their community of origin by (100%), and after determining the measuring tools and preparation of exercises applied with rubber r

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Crossref
Publication Date
Mon May 20 2019
Journal Name
Ibn Al-haitham Journal For Pure And Applied Sciences
Numerical Solution for Classical Optimal Control Problem Governing by Hyperbolic Partial Differential Equation via Galerkin Finite Element-Implicit method with Gradient Projection Method
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     This paper deals with the numerical solution of the discrete classical optimal control problem (DCOCP) governing by linear hyperbolic boundary value problem (LHBVP). The method which is used here consists of: the GFEIM " the Galerkin finite element method in space variable with the implicit finite difference method in time variable" to find the solution of the discrete state equation (DSE) and the solution of its corresponding discrete adjoint equation, where a discrete classical control (DCC) is given.  The gradient projection method with either the Armijo method (GPARM) or with the optimal method (GPOSM) is used to solve the minimization problem which is obtained from the necessary conditi

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Crossref
Publication Date
Fri Jan 01 2021
Journal Name
International Journal Of Clinical Dentistry Preview Publication Details
The effect of surgical approaches on the stability and marginal bone loss of early loaded slactive implants with screw retention mean: Comparative clinical and radiological prospective study
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Purpose: This study aimed to compare the stability and marginal bone loss of implants inserted with flapped and flapless approaches 8 weeks after surgery and 3 months after loading. Material and Methods: Thirty SLActive implants were inserted in 11 patients and early loaded with final restoration 8 weeks after healing period. The stability values determined by Osstell and the marginal bone loss measured by CBCT at the initial time (1st) and 8 weeks of the healing period (2nd) and 3 months after loading (3rd). Results: The overall survival rate was 100%. A significant increase in the 3rd implant stability value in the age of ˂ 40. A significant decrease in the 2nd implant stability value in both gender and traumatic zone with a flapless app

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Scopus
Publication Date
Fri Dec 15 2017
Journal Name
Journal Of Baghdad College Of Dentistry
The Effect of Oral Contraceptive Pill on Cortical Thickness and Bone Mineral Density of The Mandibular Mental and Gonial Regions in Premenopausal Females Using Spiral Computed Tomography
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Background: Prolonged use of low-dose estrogen ''20 micrograms or less" Combined oral contraceptive pill (that have estrogen and progesterone steroid hormone) had an effect on bone turnover .Bone mineral density is used in clinical medicine as an indirect indicator of osteoporosis and fracture risk. The aim of the study: The aim of this study was to investigate the effect of low dose oral contraceptive pill on the cortical thickness (in millimeter) and bone mineral density at the mandibular cortex of mental and gonial regions in Hounsfield unit(HU) using spiral computed tomography. Material and method: This prospective study was conducted on computed tomographic image of 100 women aged between (20-40) years .The collected sample includes

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Crossref
Publication Date
Sun Jun 22 2025
Journal Name
Journal Of Baghdad College Of Dentistry
Hard palate bone density and thickness determination using CT scan and their relationships with body compositions measured by bioelectrical impedance analysis for Iraqi adult sample
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Background: This study was conducted to evaluate the hard palate bone density and thickness during 3rd and 4th decades and their relationships with body mass index (BMI) and compositions, to allow more accurate mini-implant placement. Materials and method: Computed tomographic (CT) images were obtained for 60 patients (30 males and 30 females) with age range 20-39 years. The hard palate bone density and thickness were measured at 20 sites at the intersection of five anterioposterior and four mediolateral reference lines with 6 and 3 mm intervals from incisive foramen and mid-palatal suture respectively. Diagnostic scale operates according to the bioelectric impedance analysis principle was used to measure body weight; percentages of body fa

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