Rigid Fixation after Intraoral Vertical Ramus Osteotomy: A Retrospective Study and Description of Technique

Abstract

The intraoral vertical ramus osteotomy (IVRO) is an osteotomy utilized in oral and maxillofacial surgery to aid in correction of mandibular and facial deformities. Traditionally, performing this osteotomy requires a period of maxillomandibular fixation (MMF) following surgery, which can have effects on the teeth, temporomandibular joints, and patient satisfaction. Completion of the IVRO can be technically difficult due to poor visualization of the lateral mandible and variation in position of the inferior alveolar nerve. The authors' institution has successfully implemented rigid fixation of IVROs that removes the need for MMF following surgery. Seventy-seven patients underwent a total of 134 IVROs between 2017 and 2020 at the institution. Thirty-eight patients had rigid fixation for a total of 65 fixated IVROs. Among patients who underwent rigid fixation of IVRO, 3 experienced temporomandibular joint dysfunction and 2 experienced paresthesia in the V3 distribution. Of 69 IVROs without fixation, 2 patients experienced temporomandibular joint dysfunction and 1 patient had paresthesia in V3 distribution. Rigid fixation of IVROs was noted to add intraoperative time but did obviate the need for postoperative MMF in patients. In this study, the authors describe their institution's method for rigid fixation of IVRO. Additionally, the authors have developed a process for fabricating custom cutting guides to aid in IVRO completion. Utilization of the cutting guides allows for pre-surgical placement of the osteotomy and eliminates the need for direct visualization intraoperatively.