Monday, April 18, 2016

A complicated thing called BSSO

A complicated thing called BSSO -several of us attended lectures and hands on sessions  at the famous Chang Gung Craniofacial Centre Taipei in 2006

Very useful,but not for the occasional player. Too complicated and time consuming.

          Oral cavity cleansed with half strength hydrogen peroxide and diluted betadine solution
          1%xylocaine in 1:200,000 epinephrine is injected into the vestibule of the mandible below the ramus on both sides
          A vestibular incision is made below the ramus and carried down to the bone
          With a periosteal elevator,subperiosteal dissection is carried down to the lateral aspect of the mandibular body and the ramus superiorly to the sigmoid notch
          The attachments of the masseter and the periosteum on the posterior aspect of the ramus are stripped off the bone with a stripper
          On the medial side of the ramus,the subperiosteal dissection is carried down to the condylar region connecting the disssection on the lateral side;great care is taken to preserve the infero alveolar nerve
          With both medial and lateral ramus retractors in place,the osteotomy lines of the saggital split osteotomy are marked by a lead pencil

          Anteriorly, the oblique line is about 5mm from the mental nerve
          Make a transverse burr  over the lingula till you see the marrow;check inf al nerve in canal
          then cut across/posteriorly burr down and split with  thin osteomes (after the anterior-burr the impaction points) ;the 2nd osteotomy is made rhrough the lateral cortex in the region of the 2nd molar
          Detach and burr the medial pterygoid insertions to prevent relapse post op: > 10 mm redn possible if combined with muscle stripping
          Set back by removing  a vertical segment of bone from the anterior aspect of the proximal lateral bony segment ;
          The width of the segment to be removed should equal that of the setback to be achieved
          Complete the same on the other side
          Occlusion is obtained with a wafer occlusal splint; the proximal segments are carefully positioned in each glenoid fossa
          burr off excess bone and fix with miniplates or screws after checking for alignment: no need for IMF
          Close angle, muscle –periosteum then the rest-insert drain anteriorly

1 comment:

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