Bilateral Sagittal Split Osteotomy (BSSO or Lower Jaw Surgery)

The bilateral sagittal split osteotomy (oss-tee-OT-uh-mee) is a common orthognathic surgery to correct irregularities in the lower jaw. Surgeons use this procedure to correctly align the lower jaw with the upper jaw to improve both function and appearance. BSSO is the most commonly performed reconstructive jaw surgery. If your child’s upper jaw also is misaligned, your surgeon may suggest doing the BSSO and LeFort 1 (upper jaw repositioning) surgeries at the same time.

We believe parents and guardians can contribute to the success of this surgery and invite you to participate. The following information can help you learn about the surgery and how you can help.

Why Choose UPMC Children’s

UPMC Children’s Hospital of Pittsburgh is a nationally ranked Top 10 children’s hospital. Our multidisciplinary team of specialists perform dozens of orthognathic (jaw) surgeries each year, including BSSO. We are trained in complex craniofacial reconstruction, functional airway surgery, and facial aesthetics.

Our plastic surgery team at UPMC Children’s includes surgeons, orthodontists, anesthesiologists, and nurses are specially trained in caring for children. They are dedicated to helping children function at the highest level by treating both common and complex surgical issues.

Children’s is the region’s leading pediatric referral facility and western Pennsylvania's only Level I Pediatric Trauma Center. Whether your child’s situation is severe or straightforward, a congenital impairment, or the result of an injury or trauma, you can be confident that we’ll apply our years of expertise, knowledge, and experience to help your child.

Fast Facts about Bilateral Sagittal Split Osteotomy (BSSO)

  • BSSO is one of the most common procedures for treating jaw misalignment, cleft lip or palate, and upper jaw fractures.
  • It allows the lower jaw to be repositioned to reshape the face and improve the bite.
  • BSSO usually requires orthodontic work before and after the procedure.
  • The procedure is typically done when a child’s bones are mature. For girls, that is generally between ages 14 and 16, or 2 years after their first menstrual period. For boys and young men, that’s normally between ages 16 and 18.
  • Your child will be given medicines to prevent pain during their surgery. It will be based on what the anesthesiologist (AN-es-theez-e-ol-o-gist) decides is best for your child.
  • This surgery takes 2 to 3 hours.
  • BSSO surgery is performed entirely inside your child’s mouth so there will be no visible scars on their face.
  • Children who undergo a BSSO procedure typically spend 1 night in the hospital.

The Surgery

Your child’s BSSO procedure will be done at UPMC Children’s Hospital in Lawrenceville.

When you have checked in, you and your child will be called to an examination room where your child’s health history will be taken and vital signs will be checked. You’ll meet with one of the doctors, including a doctor from anesthesia, on your child’s surgical team to go over the surgery. They will answer any last-minute questions you might have.

When it is time for your child to go the operating room, you’ll be asked to wait in the surgical family waiting area.

A Parent’s/Guardian’s Role

The most important thing you can do as the parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.

During the surgery, at least one parent or guardian should remain in the surgical family waiting area at all times in case the family needs to be reached.

While Asleep

While your child is asleep, their heart rate, blood pressure, temperature, and blood oxygen level will be checked continuously. When the surgery is over, the medicines will be stopped and your child will begin to wake up.

Waking Up

When your child is moved to the recovery room, you’ll be called so that you can be there as they wake up. You and your child will stay in the recovery room to be watched over until they are alert and stable.

Going Home

Your child will likely stay in the hospital overnight. When it’s time to go home, an antibiotic and oral pain medicine will be provided to help them heal and be more comfortable. An oral antibiotic rinse also may be prescribed.

Follow Up

You’ll be given your child’s follow-up plan before you leave the hospital. This will tell you when to schedule your child’s follow-up appointment. It will be coordinated with your surgeon and Children’s Orthodontics — likely about a week after surgery.

An orthodontic washout/cleanout will be scheduled within 3 days of surgery. This may occur while your child is in the hospital or as an outpatient.

Helpful Tips

  • Swelling is normal after this surgery.
    • It generally increases for 2 to 3 days after the surgery and can be worse in the morning for the first few days.
    • Most swelling resolves after about 2 weeks. Call if the swelling goes away and then comes back, or if there is new redness or fever associated with the swelling.
  • Most discomfort will be from swelling of the face rather than pain from the surgery.
    • You will receive medicine to help with discomfort.
    • Sleeping with your head elevated can help decrease swelling.
    • Ice packs or frozen bags of peas can also be used to help with discomfort and swelling.
    • Unless otherwise instructed, your child may continue to wear the jaw bra for comfort.
  • It is normal for lips to be swollen and sore after this surgery.
    • We will have you use a 1% hydrocortisone cream on your lips for the first 3 days after surgery.
    • After the initial 3 days, use Vaseline® for comfort.

At-Home Care

You’ll be given information about how to help your child when you get home. This will include any medicines to give your child and details on postoperative care as they heal. Your child might feel sick to their stomach (nauseated) right after surgery. Our care team can provide support if needed.

Your child will be on a clear liquid diet (anything you can see through) initially, then transition to full liquids as tolerated within the first 24 to 48 hours after surgery. They will then transition to a full liquid diet (anything pourable or blended).

  • It is very important to listen to the surgeon’s and orthodontist’s directions regarding the types of foods you can eat following the surgery and when it is safe to eat them.
  • Eating appropriate foods will help with the healing, but eating hard foods too early can damage the surgery.

Avoid heavy lifting, vigorous activity, and any activity that could result in trauma, such as gym or sports.

If you have ANY concerns, we are always happy to talk with you.

Special Needs

If your child has any special needs or health issues you feel the doctor needs to know about, or if you have any questions, please call 412-692-6845 before the surgery and ask to speak with the nurse. It is important to notify us in advance about any special needs your child might have.

If you need help after hours, call the UPMC Children’s operator at 412-755-2318 and ask them to page the doctor who is on-call for your child’s procedure.

Contact Us

To schedule an appointment with the Division of Pediatric Plastic Surgery, call 412-692-8650. Online scheduling is also available for both in-person and video visits.

Our Location

UPMC Children’s Hospital of Pittsburgh
4401 Penn Ave.
Floor 3
Pittsburgh, PA 15224