Clinical Approach for Mandibular Advancement by Intraoral Vertical Ramus Osteotomy With Endoscopically Assisted Intraoral Fixation of an L-Shaped Compact Lock Plate

Abstract

Intraoral vertical ramus osteotomy (IVRO) is widely used as a surgical corrective method to treat patients with skeletal class III malocclusion with mandibular setback. However, the conventional surgical method applied for mandibular advancement has induced such complications as condylar luxation caused by the instability of the placement of the proximal segment. To avoid this complication, it has been necessary to use the fixation of the proximal and distal segments with an L-shaped compact lock plate via an extraoral approach. This has made surgeons hesitate to propose this osteotomy for patients with skeletal class II malocclusions. We herein report a new surgical approach for the IVRO for mandibular corrective advancement with endoscopically assisted fixation of an L-shaped compact lock plate and good positioning of the condyle via an intraoral approach.The osteotomized mandibular segments were fixed with an L-shaped compact lock plate using right-angled burs and right-angled screwdrivers. Seven patients were included in this study. The average degree of mandibular advancement was 6.1 mm (range, 3.5-9 mm). Our results suggest that mandibular advancement by IVRO with endoscopically assisted intraoral fixation of an L-shaped compact lock plate in patients with skeletal class II malocclusion might be useful to improve the occlusion and facial aesthetics by maintaining good positioning of the condyle.