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Intra operative complications of sagittal split ramus osteotomy


  • Zahid Qayyum
  • Adnan Aslam
  • Mohammad Yunus
  • Pareesa Rahman
  • Uzair Luqman
  • Syed Adnan Ali Shah


Lower mandibular third molar (wisdom tooth), sagittal split ramus osteotomy (SSRO), inferior alveolar nerve (IAN), temporomandibular joint (TMJ)


Introduction: Sagittal split osteotomy of the mandible is frequently used to correct dentofacial deformities. Many complications are associated with this surgical procedure. Hence the objective of this study was to evaluate intraoperative complications associated with surgical advancement of the mandible by sagittal split ramus osteotomy (SSRO) and to analyze whether occurrence of complications was associated with concomitant third molar extraction on the operating side or not.

Material and Methods: A total of 22 patients comprised the sample for this study. 42 had bilateral sagittal osteotomy procedure performed. On 19 sides, third molar extraction was done simultaneously during the surgical procedure. Chi sqaure test was applied to see the association between timing of extraction and intra-operative complications. The p value was found to be 0.023 which was statistically significant.

Results: The results showed that the mean age of patients was 23.10±3.46 years. In 11 (50%) patients single jaw osteotomy was performed while 11 patients (50%) had double jaw osteotomy. 36 out of 42 sides (85.7%) had no major complications. A total of 3 sides (7.1%) had bad splits; bad split of lingual cortical (distal) segment, of buccal cortical (proximal) segment sparing lower border, split extending to posterior border. The IAN was visibly injured during surgery in 3 (7.2%) sides, of which 1 side (2.4%) represented total transaction of the nerve which was primarily repaired and in 2 sides (4.8%), nerve was entrapped between osteotomized segments but was freed successfully.  Intra-operative complications were more on the right side as compared to left side.

Conclusions: It was concluded that although SSRO is overall a safe and predictable procedure, meticulous attention must be paid to prevent troublesome complications and wherever possible, mandibular third molars should be removed at least 6-9 months before the operative procedure.

Author Biographies

Zahid Qayyum

BDS, FCPS,, Assistant Professor, Dept. of Oral & Maxillofacial Surgery (OMFS), Margalla Institute of Health Sciences, Rawalpindi

Adnan Aslam

Assistant Professor & Head, Dept. of OMFS, Margalla Institute of Health Sciences, Rawalpindi.

Mohammad Yunus

BDS, MDS, Principal, Margalla Institute of Health Sciences, Rawalpindi.

Pareesa Rahman

BDS, FCPS, FFD RCSI, Assistant Professor, Dept of OMFS, Frontier Medical College, Abbotabad.

Uzair Luqman

BDS, FCPS, FFD RCSI, Consultant Oral & Maxillofacial Surgeon, KRL General Hospital, Islamabad.

Syed Adnan Ali Shah

BDS, MDS, FRACDS, FDS RCS, FFD RCSI, FCPS (Hon) Professor & Chairman; Division of OMFS, Head; Department of Dental Diagnostic & Surgical Sciences, Faculty of Dentistry, University of Manitoba, Winnipeg, Canada.




How to Cite

Qayyum, Z., Aslam, A., Yunus, M., Rahman, P., Luqman, U., & Shah, S. A. A. (2014). Intra operative complications of sagittal split ramus osteotomy. Pakistan Orthodontic Journal, 6(2), 65–71. Retrieved from



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