Management of A Bad Split Complication: A Systematic Review

Naaila Afifah1, Tantry Maulina2, *, Abel Tasman Yuza2
1 Faculty of Dentistry, Universitas Padjadjaran, Indonesia
2 Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Indonesia

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© 2022 Afifah et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Universitas Padjadjaran, Indonesia; Tel: +62 82115513030; E-mail:



Bad split is one of the well-known intra-operative complications that occur during the bilateral sagittal split osteotomy (BSSO) procedure, which is a rehabilitation procedure for patients with mandibular deformities. The prevention of further post-surgery complications required sufficient management of bad split complications.


This study aimed to analyze the management of bad split complications during a BSSO procedure.


The literature review was conducted in the form of library research in the field of bad split complications' management by a BSSO based on the Preferred Reporting Items for Systematic Reviews (PRISMA). Related studies were found through using a manual search using Pubmed, ScienceDirect, Ebscohost, Scopus, Medline, Embase, and Web of Science, among other search engines. The inception of incorporation standards, the process of data extraction, and the determination of the risk of bias were carried out by the authors. The process of data screening was conducted by applying the inclusion and exclusion criteria.


This paper systematically reviewed seven related studies, four of which were case series and two of which were cross-sectional. The utilization of additional osteosynthetic plates was revealed throughout the extraction process as the most acquainted course of action to manage the bad split complications during the BSSO procedure.


The osteosynthetic plate and miniplate application with bicortical or monocortical screws were exposed as the most used treatment for bad split complications.

Keywords: Bad split, Unfavorable fracture, Bilateral sagittal split osteotomy, Sagittal split ramus osteotomy, Treatment, Surgery complication.