Cortical bone thickness of the mandibular canal and implications for bilateral sagittal split osteotomy: a cadaveric study

Preoperative delineation of the mandibular canal and surrounding cortical bone thickness is mandatory prior to bilateral sagittal split osteotomy (BSSO). The cortical bone thickness of 101 cadaveric mandibles was measured to define the mandibular canal. The mandibles were cut at the anterior ramus, at the third, second, and first molar, and at the premolar. The cortical bone thickness was measured between the mandibular canal and inferior border, buccal cortex, and lingual cortex at each cutting point. No difference was found between the right and left sides of the mandible, or between males and females, with one exception: males were found to have thicker inferior cortical bone at the premolar site than females. The implications for BSSO are: (1) for sagittal bone cutting, the maximum cutting depth of the buccal cortex at the ramus is 4.5 mm, at the second and third molars is 6.5 mm, and at the first molar is 5 mm; (2) for vertical bone cutting at the first molar, the maximum cutting depth from the inferior border is 7.5 mm. The measurement of cortical bone thickness from cadaveric mandibles provides useful preoperative information and confirms the results of computed tomography.