Bilateral sagittal split
osteotomy (
BSSO) and
distraction osteogenesis (DO) are the most common techniques currently applied to surgically correct mandibular
retrognathia. It is the responsibility of the maxillofacial surgeon to determine the optimal treatment option in each individual case. The aim of this study was to review the literature on
BSSO and mandibular DO with emphasis on the influence of age and post-surgical growth, damage to the inferior alveolar nerve, and post-surgical stability and relapse. Although randomized clinical trials are lacking, some support was found in the literature for DO having advantages over
BSSO in the surgical treatment of low and normal mandibular plane angle patients needing greater advancement (>7 mm). In all other mandibular
retrognathia patients the treatment outcomes of DO and
BSSO seemed to be comparable. DO is accompanied by greater patient discomfort than
BSSO during and shortly
after treatment, but it is unclear whether this has any consequences in the long term. There is a need for randomized clinical trials comparing the two techniques in all types of mandibular
retrognathia, in order to provide evidence-based guidelines for selecting which
retrognathia cases are preferably treated by
BSSO or DO, both from the surgeon's and the patient's perspective.