Vertical subsigmoid osteotomy fixation with miniplates: a case report

Abstract

Fig. 1. Intraoperative photograph of fixation technique. ntraoral vertical subsigmoid osteotomies are utilised in our epartment for mandibular setback procedures in skeletal lass III cases. Traditionally we have placed these patients into intermaxllary fixation at operation utilising an occlusal acrylic wafer nd box wires. Recently we chose to fix the VSS osteotomy ith 2 mm miniplates placed intraorally to allow mouth openng and reduce airway compromise post operatively. We are naware of any literature describing this technique although n endoscopic technique has been reported,1,3,4 as well as the se of biodegradable screws.2 Following a standard intraoral vertical subsigmoid steotomy using a right angled oscillating saw, the patient was laced into IMF with a final occlusal acrylic wafer. The proxmal condylar fragment was reduced in height by removing he inferior 1 cm of posterior ramus. The proximal fragment was then held laterally by passing 3/0 PDS through a hole drilled with a fissure bur through the nferior aspect and suturing this to the masseteric periosteum. ‘L’ shaped 2 mm plate was then adapted to the anterior spect of the proximal fragment and the ramus and external blique ridge of the distal fragment. 6–8 mm monocortical screws were used to fix the steotomy via the intraoral route without requiring a ransbuccal trochar – Fig. 1.