Journal Article

Anatomical factors associated with the lingual fracture pattern in sagittal split ramus osteotomy: A case-control study

Moreira Suassuna, Thalles, Fonseca Faro, Tatiane, Araújo, Fábio Andrey da Costa, de Melo Filho, Sérgio Murilo Cordeiro, de Castro, Carla Cecília Lira Pereira, Araújo, Fernanda Souto Maior dos Santos, dos Santos, Elenisa Glaucia Ferreira, Martins-de-Barros, Allan Vinícius

2025

Overview

Unfavorable fractures are among the most challenging complications in sagittal split ramus osteotomy (SSRO), potentially increasing surgical morbidity and compromising postoperative outcomes. The preoperative identification of anatomical risk factors through imaging can enhance surgical planning and prevent such events. This study aims to investigate the anatomical factors associated with lingual fracture patterns in SSRO using multislice computed tomography. This retrospective case-control study included 180 mandibular rami from patients who underwent SSRO at a Clinical Research Center for Oral and Maxillofacial Surgery. Fractures were classified according to Plooij (2009), with Types 3 and 4 grouped as cases and Types 1 and 2 as controls. Linear measurements of mandibular ramus thickness, the distance between the mandibular canal and the buccal cortical bone, as well as parameters related to the mandibular lingula were analyzed. The case group showed significantly thinner mandibular bone (p < 0.001) and a shorter canal-cortical distance (p = 0.013), suggesting a direct association between these anatomical variables and unfavorable fracture patterns. Bonferroni post hoc analysis revealed no significant difference between fracture patterns Type 3 and Type 4 (p = 1.000), supporting their grouping in a single analytical category. The presence of third molars was not significantly associated with fracture patterns (p > 0.05). These results underscore the importance of anatomical parameters in predicting the risk of unfavorable fractures. Specifically, reduced bone thickness and proximity of the mandibular canal play a crucial role in the occurrence of unfavorable SSRO fractures. Preoperative evaluation using computed tomography is essential to optimize surgical planning and minimize complications. However, given the limitations of retrospective designs potential biases are acknowledged, and further prospective studies are needed to confirm these findings and improve risk assessment in SSRO.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Adult / Biology and Life Sciences / Case studies / Case-Control Studies / Complications and side effects / Computed tomography / Cortical bone / Female / Fractures / Humans / Injuries / Male / Mandible / Mandible - diagnostic imaging / Mandible - surgery / Mandibular canal / Mandibular Fractures - diagnostic imaging / Mandibular Fractures - etiology / Maxillofacial / Medical examination / Medical imaging / Medicine and Health Sciences / Middle Aged / Molars / Morbidity / Multidetector Computed Tomography / Oral surgery / Osteotomy / Osteotomy, Sagittal Split Ramus - adverse effects / Parameters / Research and Analysis Methods / Research facilities / Retrospective Studies / Risk assessment / Risk Factors / Root canals / Software / Statistical analysis / Surgery / Thickness / Trauma / Variables / Young Adult