Bilateral Sagittal Spilt Osteotomy and Genioplasty in Patient with Lymphatic Malformation

Bilateral Sagittal Spilt Osteotomy and Genioplasty

horizontal mandibular excess or asymmetry, need for mandibular advancement

co-morbidities increasing surgical risk

#9 Periosteal Elevators
3-0 Vicryl Suture

supine, nasal intubation, general anesthesia, Inferior alveolar nerve block

Dental impressions, 3D CT, photos, collected; precise cuts planned and post-operative appearance simulated; Post-op chin strap constructed. History & Physical Exam, CBC, Coagulation Profile, CMP, ASA Classification

With intra-oral incision, watch for 'dimple' of Stensen's duct in the region of the 2nd maxillary molar. Mucosa is incised at anterior border of the ramus, exposing the external oblique ridge, from the coronoid notch to the second molar. Reciprocating saw passed down the oblique ridge, approximately to the level of the 2nd molar, and then vertically down the inferior mandibular border. For genioplasty note course of the inferior alveolar nerve exiting the mental foramen usually ~ 5mm below this foramen between the 1st and 2nd pre-molars.

bleeding following injury to the masseteric or inferior alveolar artery, unanticipated splits/fractures, witches-chin deformity from improper mentalis muscle suspension, damage to Inferior alveolar or mental nerve

bleeding following injury to the masseteric or inferior alveolar artery, unanticipated splits/fractures, witches-chin deformity from improper mentalis muscle suspension, damage to Inferior alveolar or mental nerve

Bilateral Sagittal Split Osteotomy, Laura A. Monson, MD. Semin Plast Surg. 2013 Aug; 27, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805998/