Rigid fixation of intraoral vertico-sagittal ramus osteotomy for mandibular prognathism.

概要

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The standard surgical treatment for prognathism is sagittal split ramus osteotomy (SSRO) if the proximal and distal segments of the ramus require fixing with screws or metal plates. In this procedure, however, it is frequently difficult to avoid neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) when the posterior margin of the ramus curves inward or when the ramus is thin (Fig 1A, B). This report describes a new alternative procedure, intraoral vertico-sagittal ramus osteotomy (IVSRO),1 a modification of SSRO and intraoral vertical ramus osteotomy (IVRO). One of the main advantages of IVSRO is that it avoids IAN damage, because the ramus can be split parallel to the original sagittal plane posterior to the point between the mandibular canal and the lateral cortical bone plate immediately in front of the antilingular prominence. Another advantage of IVSRO is that the area in which screws can be inserted is relatively large, if the subcoronoid area on the distal segment and subcondylar area on the proximal segment are used. The 2 segments can be fixed in these areas with bicortical bone screws, with or without a cheek incision (Fig 1C). This report introduces rigid fixation of IVSRO for mandibular prognathism.