Modification of intraoral vertical ramus osteotomy

Abstract

s g ntraoral vertical ramus osteotomy (IVRO) has a low risk f injury to the inferior alveolar nerve during mandibular etback. It is also efficacious for disorders of the temporoandibular joint, 1 and results in predictable postoperative tability.2 However, it can result in lateral flaring of proxmal segments or inadequate setback resulting from bony nterference. These complications can be managed with corooidotomy, though it prolongs recovery. In this report we ntroduce a modification of IVRO to minimise interference nd lateral flaring. A mucosal incision 4 cm long is made over the external blique ridge, and broad dissection over the lateral ramus. pair of Bauer retractors is placed in the sigmoid and ntegonial notches to visualise the antelingular prominence, nd a conventional double slide osteotomy done. A round scillating saw is used to make the angle at the antelinular prominence easier. The saw blade is then directed nterosuperiorly (Fig. 1a) towards the sigmoid notch, and wedge-shaped osteotomy made. Bleeding from the internal maxillary artery can be preented with the Bauer retractors and by avoiding deep lacement of the blade during the osteotomy. The wedge ragment from the YVRO is removed before dissection of the