The practical method and its results to decide the precise position of the ascending ramus for the bicortical screw fixation in sagittal split osteotomy.

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The bicortical screw fixation of the ascending ramus in sagittal split osteotomy presents many advantages, such as the short period of intermaxillary fixation, the diminution of relapse and so on. To secure successful results in the maneuver, the most important procedure is to settle the lateral fragment of ascending ramus in a precise position at the time of fixation. A facile technique was contrived and applied to eighteen cases of sagittal split. The method is as follows: 1. Just prior to splitting, intermaxillary ligation is performed in order to fix the ascending ramus at the position of central occlusion. 2. A V-shaped notch is engraved on the anterior edge of the ascending ramus at the level of the maxillary dental arch. 3. A flexible metal frame for Schuchardt-Schiene is adjusted such that the terminal hook may fit to the notch and two or three hooks are plunged into the interdental spaces of the maxillary arch.Thus the position of the ramus is surveyed using the maxillary teeth as the landmarks. 4.After splitting, intermaxillary ligation is performed again.The metal frame is adjusted to the maxillary arch.The notch of the lateral ascending ramus is fitted to the terminal hook. Thus the lateral ascending ramus is settled in the same position before splitting. 5. Both fragments are fixed using metal or sapphire screws in the manner described elsewhere. The divergence in the position of the ascending ramus was analysed in seventeen cases. The goniometrical differences of the ascending ramus were estimated by superim posing lateral X-ray films obtained in pre-and postsurgical stage. The values were very small ranging from 1 degree to 10 degrees with an average of 3.9 degrees.Neither severe symptoms, such as longstanding pain and trismus, nor functional disturbances were observed clinically.
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The practical method and its results to decide the precise position of the ascending ramus for the bicortical screw fixation in sagittal split osteotomy.

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