Efficacy and outcomes of fixation methods in bilateral sagittal split ramus osteotomy: a comprehensive review of stability, neurosensory disturbances and TMJ disorders

Introduction: Bilateral sagittal split ramus osteotomy (BSSO) is a commonly performed procedure for correcting mandibular prognathism and retrognathism. Numerous modifications to the technique along with the use of bicortical and monocortical screw fixation systems, have been developed to enhance stability, aesthetics and function. This review explores the stability, relapse rates, neurosensory disturbances (NSD) and temporomandibular joint (TMJ) dysfunction associated with different fixation methods in BSSO. Methods: A comprehensive literature review of studies evaluating the outcomes of BSSO was performed. Factors such as skeletal stability, NSD, TMJ symptoms and the impact of fixation methods were examined. Comparative analyses of bicortical and monocortical screws were conducted to assess their efficacy and complications. Results: Bicortical screw fixation demonstrated better long-term stability and cost-effectiveness compared to monocortical systems with relapse rates varying based on fixation type and surgical scenarios. NSD particularly inferior alveolar nerve (IAN) injury were the common complications. Recovery rates were influenced by patient age, surgical duration and nerve manipulation. TMJ dysfunction outcomes indicated improvement in symptoms for most patients postoperatively, though pre-existing conditions and specific anatomical factors increased risk. Conclusion: BSSO remains a reliable procedure for addressing mandibular discrepancies. Bicortical screws offer enhanced stability but are associated with higher risks of neurosensory complications. Multidisciplinary approaches and individualized treatment planning can optimize functional and esthetic outcomes while minimizing complications such as relapse, NSD and TMJ dysfunction.