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Original Article Plastic and Aesthetic Research

A guiding oblique osteotomy cut to prevent

bad split in sagittal split ramus osteotomy:

a technical note

Gururaj Arakeri , Peter A. Brennan 2
1
1 Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Raichur 584101, Karnataka, India.
2 Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY, UK.
Address for correspondence: Dr. Gururaj Arakeri, Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital,
Raichur 584101, Karnataka, India. E-mail: gururaj.arakeri@gmail.com

ABSTRACT
Aim: To present a simple technical modification of a medial osteotomy cut which prevents
its misdirection and overcomes various anatomical variations as well as technical problems.
Methods: The medial osteotomy cut is modified in the posterior half at an angle of 15°-20° following
novel landmarks. Results: The proposed cut exclusively directs the splitting forces downwards to
create a favorable lingual fracture, preventing the possibility of an upwards split which would cause
a coronoid or condylar fracture. Conclusion: This modification has proven to be successful to date
without encountering the complications of a bad split or nerve damage.

Key words:
Guiding oblique osteotomy cut, lingual bad splits, medial cut, sagittal split ramus osteotomy

INTRODUCTION Various studies have reported an incidence of bad splits
ranging from 1.7% to 9.1%. Although the most common
[4]
Sagittal split osteotomy of the ramus may be the procedure unfavorable splits involve a buccal plate fracture, these
which defined the evolution of the art and science of oral bad lingual splits may result in serious complications
surgery. Although the basic design of the sagittal split including fracture of the lingual cortical plate, condylar
ramus procedure evolved very quickly, the elimination of neck and coronoid process. [4]
complications has taken longer. The procedure has been The purpose of this article is to suggest a modification of
[1]
modified many times since its introduction by Trauner the medial osteotomy cut which will prevent misdirection
and Obwegeser. One modification frequently used is a while overcoming anatomical variations and technical
[2]
shortened medial horizontal osteotomy, which, instead problems.
of extending the cut to the posterior border, is carried
[3]
only to the lingual fossa posterior to the lingula. In
the majority of cases, this technique allows for adequate METHODS
[3]
splitting of the mandible. However, this modification
is not devoid of complications, as the medial cut can be Surgical access for the sagittal split osteotomy is
misdirected due to anatomic variability of the ramus, or performed in the standard fashion. Following fine
an improperly directed osteotomy cut, resulting in a bad dissection over the anterior border of mandible, the
lingual split. insertion of the temporalis muscle is detached and
elevated to the level of the sigmoid notch. The anterior
ramus is then isolated with retraction of the soft tissues.
Access this article online The medial ramus is accessed by subperiosteal insertion of
Quick Response Code: a malleable retractor above the foramen, and the inferior
Website:
www.parjournal.net alveolar nerve is identified at the level of the lingula.
The medial osteotomy cut is directed parallel to the
[3]
DOI: occlusal plane [Figure 1] at the level of superior aspect
10.4103/2347-9264.157105 of lingula in the standard fashion, but ends at a point
midway between the lingula and the ascending ramus.
Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015 127