Abstract
Context: Using a reliable fixation method after ramus sagittal split osteotomy in order to reduce the chances of treatment relapse
and condyle changes is still one of the most noteworthy issues discussed among maxillofacial surgeons. In this study, the results
of the up-to-date papers were collected, which identify the effects of the fixation method on the post-operative results, to give the
reader a comprehensive view of the new concepts.
Evidence Acquisition: The most frequent mandibular surgeries, setbacks, and advancements via the bilateral sagittal split osteotomy
technique were used for a literature search due to the abundance of related articles. Consequently, the following keywords
were applied: sagittal split ramus osteotomy, orthognathic surgery, rigid fixation, non-rigid fixation, postoperative relapse, and
postoperative stability.
Results: The articles were classified according to the surgery procedure: mandibular advancement surgery or mandibular setback
surgery. The relapse pattern can be divided into two categories: an early relapse, which is strongly related to the surgery procedure,
and a late relapse, which can be attributed to the physiologic changes, such as a growth map. The contributing factors can be
considered to be the following: a change in ramus in inclination, the mandibular plane, and the fixation type.
Conclusions: Using rigid fixation techniques after bilateral sagittal split ramus osteotomy will optimize the stability, but this stability
is not influenced by the method of this rigid fixation; although the most commonly suggested technique, bicortical screws,
is in the inverted-L position