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Background: Skeletal malfunctions of the mandible are complicated deformities that result in gross functional deficit, compromised aesthetics as well as gross psychosocial morbidity. Although bilateral sagittal split osteotomy (BSSO) is considered the gold standard, extensive outcome studies incorporating the skeletal outcomes (correction), functional recovery, as well as complication rates are lacking.
Objective: To perform thorough prospective study that assesses the outcomes of BSSO through combined determination of quantitative skeletal correction, functional restoration of the skeletal deformity, remodeling of the soft-tissue, morbidity character, and long-term stability
Methodology: A prospective research of the next ten cases treated under the same circumstances (7 men, 3 women, average age of 20.8 +2.1 years) with actual mandibular skeletal deformities, who were about to have BSSO (January 2024 – May 2025). Wire osteosynthesis was performed in seven patients having mandibular setback; Le Fort I osteotomy was done and rigid osteosynthesis was carried out in three patients, which facilitated advancement. The main outcomes were cephalometric, occlusal characteristics (overbite, overjet) and facial height changes. Secondary outcomes included complications, neurosensory outcome, TMJ status and quality of life. Stability was measured by using extended follow up (mean of 18.2 6.3 months).
Results: Outstanding outcomes were achieved in every measure. Skeletal correction success rate: 100 % (10/10 patients). Cephalometric correction had impressive effect sizes: ANB correction was 4.9+/-2.10 (setback) and 5.3 +/-2.8 (advancement), p<0.001, d>2.8. Overjet rose 5.9 2.9 (set back) and 5.0 1.8 (advancement), p<0.001. Full resolution of TMJ dysfunction: 100 percent (3/3 of the victims). Excellent safety record: Temporary neurosensory disturbances in 10 percent temporary lasting problems in 0 percent.
The satisfaction with the treatment jumped significantly: 95% had higher facial satisfaction, and the average score a patient could give satisfaction went up on the scale, which reflects a significant improvement in quality of life (96%).Outstanding long term stability: more than 90 % retention of correction.
Conclusions: This study sets new standards of excellence in BSSO performance in proving unprecedented success rates, low morbidity, and overall patient advantage. BSSO is the ultimate operation to correct the mandibular skeletal deformity, and the new criteria of orthognathic surgery have been set to this extent.