Uncovering the Evolution of the Bilateral Sagittal Split Osteotomy: A Journey Through Time

ABSTRACT Background Orthognathic surgery has been a common practice among Oral & Maxillofacial surgeons for many years, to correct dentoskeletal discrepancies and consequently improve facial harmony. Among the different mandibular osteotomies used, the far most used is the bilateral sagittal split osteotomy (BSSO). During this time, the design of BSSO has undergone various technical changes. The aim of this historical review was to provide an overview of the modern alterations of the BSSO and to stimulate future discussions regarding the minimally invasive concept in orthognathic surgery. Methods This scoping review assessed the literature related to the BSSO in orthognathic surgery and performed a comprehensive review of the technical changes that have taken place in the design of this osteotomy over the years. Results The authors have observed that the most recent modifications in the osteotomy design are related to a shorter osteotomy, which is paradoxical as it seeks to overcome the disadvantages found in the traditional design. This modification has created a certain level of debate among the surgeons, leading to questions about the technique. The bilateral sagittal split osteotomy has undergone significant changes in recent years, and the minimally invasive concept in orthognathic surgery remains a topic of ongoing discussion. Conclusions The authors hope that this historical review will encourage further debates and research in this field.