Body Osteotomy Research Articles

Bone repair in mandibular body osteotomy after using 2.0 miniplate system – histological and histometric analysis in dogs

The objective of this study was to evaluate the bone repair along a mandibular body osteotomy after using a 2.0 miniplate system. Nine adult mongrel dogs were subjected to unilateral continuous defect through an osteotomy between the mandibular 3rd and 4th premolars. Two four-hole miniplates were placed in accordance with the Arbeitgeimeinschaft für Osteosynthesefragen Manual. Miniplates adapted to the alveolar processes were fixed monocortically with 6.0-mm-length titanium alloy self-tapping screws, whereas miniplates placed near the mandible bases were fixed bicortically. At 2, 6 and 12 weeks, three dogs were sacrificed per period, and the osteotomy sites were removed, divided into three thirds (Tension Third, TT; Intermediary Third, IT; Compression Third, CT) and prepared for conventional and polarized light microscopy. At 6 weeks, while the CT repaired faster and showed bone union by woven bone formation, the TT and IT exhibited a ligament-like fibrous connective tissue inserted in, and connecting, newly formed woven bone overlying the parent lamellar bone edges. At 12 weeks, bone repair took place at all thirds. Histometrically, proportions of newly formed bone did not alter at TT, IT and CT, whereas significantly enhanced bone formation was observed for the 12-week group, irrespective of the third. The results demonstrated that although the method used to stabilize the mandibular osteotomy allowed bone repair to occur, differences in the dynamics of bone healing may take place along the osteotomy site, depending on the action of tension and compression forces generated by masticatory muscles.

A biomechanical comparison of external skeletal fixation and plating for the stabilization of ilial osteotomies in dogs

This in vitro study compares the biomechanical properties of two methods of ilial fracture repair in dogs. Ten pelves were harvested from skeletally mature mixed breed dogs weighing 20-27 kg and bilateral oblique ilial body osteotomies were created. One hemipelvis from each dog was stabilized with a 2.7 mm plate and screws and the contralateral hemipelvis was stabilized with a five pin linear external fixator construct. Each hemipelvis was mounted at an angle of 30 degrees to an actuator platform, such that the acetabulum was centrally loaded by a steel sphere attached to the load cell of a servohydraulic materials testing machine. The construct was loaded at a constant rate of 20 mm/min. A load/displacement curve was generated for each hemipelvis by plotting the sustained load against the actuator movement. The stiffness, yield load and failure load for each hemipelvis were determined from the load/displacement curve. Bending stiffness was defined as the slope of the load/displacement curve from 100 N to yield load. The mode of failure was determined by observations made during testing and gross inspection of each specimen. The mean construct stiffness, yield load and failure load were compared between stabilization groups using a Student's paired t-test with statistical significance set at p<0.05. Nine out of 10 of the hemipelves that were stabilized by plates and screws failed catastrophically by fracture through the caudal screw holes and nine out of 10 of the hemipelves that were stabilized using an external fixator failed by fracture of the ischium in the region supported by the mounting roller, propagating through the most caudal ischial pin. There was not any significant difference (P=0.22) in bending stiffness between stabilization techniques, but yield (1467 N vs 2620 N; P=0.04) and failure (1918 N vs 2687 N; P=0.002) loads were significantly greater for hemipelves stabilized with external fixators.

Nicotine impairs distraction osteogenesis in the rat mandible

Distraction osteogenesis (DO) has gained clinical acceptance as a surgical technique for treatment of congenital craniomaxillofacial deficiencies requiring skeletal expansion. The use of this technique elsewhere requires more information on overcoming difficult clinical settings, for which new animal models will be needed. The aim of this study was to develop and validate a model of impaired DO of the rat mandible with nicotine. Twenty rats underwent a right vertical mandibular body osteotomy, after which distraction began with custom-made percutaneous devices and a 3-day latency period, 6-day distraction (0.25 mm twice daily) and 30 days of neutral fixation. Rats received either nicotine or placebo slow-release pellets. Specimens were analysed after removal of the devices for quantitative radiographic bone fill, amount of bone advancement and histological features. The mean radiographic bone-fill score with nicotine treatment was 75% of that with placebo ( P = 0.0036). The nicotine-treated rats had less (49%) elongation than the placebo-treated controls ( P = 0.0008). Histological analysis demonstrated less bone, vascularity and cellular activity in nicotine-treated rats. This study shows that nicotine reproducibly inhibits osteogenesis, vascularity and bone lengthening in mandibular DO.

Poster 206: Revisit of Mandibular Body Osteotomy for Correction of Mandibular Prognathism: A Case Report

Mandibular body osteotomy became less common recently for correction of mandibular prognathism because of complications such as inferior alveolar nerve injury and developing more effective surgical procedures such as mandibular sagittal split ramus osteotomy. However, there are several cases which seemed to be an indication of this operation. In this paper, we report a case of mandibular prognathism which we performed the body osteotomy with inferior alveolar neurovascular bundle decompression in order to minimize damage to this structure. An eighteen year old man showed mandibular prognathism but the occlusion in the molar region was normal. After preoperative orthodontic treatment, the body osteotomy was performed in the missing second premolar space. Mucoperiosteal finger flap was reflected at the crest of the space to expose the inferior border of the mandible and around the mental foramen. 0.1 × 0.2 cm shaped lateral cortical plate was removed around the mental foramen and incisal branch of neurovascular bundle was severed. After that, osteotomy was performed and bone segments were fixed with mini plates. Inter maxillary fixation continued for a week after operation. One year after operation, his occlusion is stable and sensory disturbance of lower lip is not recognized. We consider this method should be a candidate for patients with mandibular prognathism, who have normal occlusion in the molar region, although decompression of the neurovascular bundle is necessary to minimize damage to this structure.

M636: Orthognathic Surgery: Treatment Planning and Surgical Techniques

Surgical techniques in orthognathic surgery have and will continue to undergo modifications and change in an effort to improve the quality of patient care and outcome. This program will present state–of–the–art surgical techniques and research results substantiating the efficacy of these surgical methods. The following modifications will be discussed:1. Genioplasty A. Augmentation B. Tenon and mortise osseous genioplasty2. Anterior mandibular subapical osteotomy3. Mandibular body osteotomy4. Mandibular ramus sagittal split osteotomy modifications A. Ramus and inferior border osteotomy B. Rigid fixation5. Maxillary osteotomy modification A. Maxillary step osteotomy and rigid fixation B. Porous block HA grafting6. Double jaw surgery A. Selective alteration of the occlusal plane B. Surgical sequencing of the maxilla and mandible C. Model surgery modifications7. TMJ factors affecting orthognathic surgery outcomesImplementation of these techniques by the experienced, skilled surgeon, coupled with accurate diagnosis and treatment planning, should provide optimal functional and esthetic outcomes for our patients. Surgical techniques in orthognathic surgery have and will continue to undergo modifications and change in an effort to improve the quality of patient care and outcome. This program will present state–of–the–art surgical techniques and research results substantiating the efficacy of these surgical methods. The following modifications will be discussed: 1. Genioplasty A. Augmentation B. Tenon and mortise osseous genioplasty 2. Anterior mandibular subapical osteotomy 3. Mandibular body osteotomy 4. Mandibular ramus sagittal split osteotomy modifications A. Ramus and inferior border osteotomy B. Rigid fixation 5. Maxillary osteotomy modification A. Maxillary step osteotomy and rigid fixation B. Porous block HA grafting 6. Double jaw surgery A. Selective alteration of the occlusal plane B. Surgical sequencing of the maxilla and mandible C. Model surgery modifications 7. TMJ factors affecting orthognathic surgery outcomes Implementation of these techniques by the experienced, skilled surgeon, coupled with accurate diagnosis and treatment planning, should provide optimal functional and esthetic outcomes for our patients.

M634: Orthognathic Surgery: Treatment Planning and Surgical Techniques

Surgical techniques in orthognathic surgery have and will continue to undergo modifications and change in an effort to improve the quality of patient care and outcome. This program will present state-of-the-art surgical techniques and research results substantiating the efficacy of these surgical methods. The following modifications will be discussed: 1Genioplasty AAugmentation BTenon and mortise osseous genioplasty 2Anterior mandibular subapical osteotomy 3Mandibular body osteotomy 4Mandibular ramus sagittal split modifications ARamus and inferior border osteotomy BRigid fixation 5Maxillary osteotomy modification AMaxillary step osteotomy and rigid fixation BPorous block HA grafting 6Double jaw surgery ASelective alteration of the occlusal plane BSurgical sequencing of the maxilla and mandible CModel surgery modifications 7TMJ factors affecting orthognathic surgery outcomes

Esthetic management of extraction sites delayed to immediate loading protocols

will continue to undergo modifications and change in an effort to improve the quality of patient care and outcome. This program will present newer treatment approaches and technical modifications, as well as the clinical and research results substantiating the efficacy of these surgical methods. The following modifications will be discussed: 1. Genioplasty A. Porous block HA and HTR augmentations B. Tenon and mortise osseous genioplasty 2. Anterior mandibular subapical osteotomy 3. Mandibular body osteotomy A. Anterior B. Posterior 4. Mandibular ramus sagittal split modifications A. Ramus and inferior border osteotomy B. Rigid fixation 5. Maxillary osteotomy modification A. Maxillary step osteotomy and rigid fixation B. Porous block HA grafting 6. Double jaw surgery A. Selective alteration of the occlusal plane B. Surgical sequencing of the maxilla and mandible C. Model surgery modifications 7. Simultaneous orthognathic surgery and rhinoplasty A. Surgical sequencing B. Rhinoplasty techniques Implementation of these techniques by the experienced, skilled surgeon, coupled with accurate diagnosis and treatment planning, should provide optimal functional and esthetic outcomes for our patients.

Mandibular Lengthening by Distraction Osteogenesis: Role of Periosteum and Endosteum

Objective: To study the role of the periosteum and endosteum in new bone formation by distraction osteogenesis.Materials and Methods: Twenty four rabbits were divided into 3 groups of perieosteum destruction (group P), endosteum destruction (group E), and a control group (group C). After right mandibular body osteotomy followed by distractor placement, the buccal periosteum in the segment between the second and third screws was removed by scalpel in group P. In group E, the endosteum was scraped out from both bone ends between the second and third screws. In group C both periosteum and endosteum were preserved during the surgical operation. After a latency period of 3 days, bone lengthening was started at a rate of I mm per day for 10 days, after which the newly formed bone was allowed to consolidate for 6 weeks with the device serving as an external fixator Radiographs were taken at the following time intervals: 2 weeks, 4 weeks, and 6 weeks after completion of distraction and 6 months after consolidation. The animals were sacrificed 6 weeks after completion of distraction and 6 months after consolidation for the gross macroscopic, histological, and radiological examinations and stability measurement of the distracted segment.Results: New bone was generated in all animal groups. The buccal cortex was incompletely formed in groups P and E but was completely formed and indistinguishable in the control group after 6 months. Histologically, the newly formed bone in the control group had a more mature appearance and better organised bone spicules than in groups P and E. In addition the remodelling process occurred more rapidly in the control group. However, quantitative analysis of the newly formed bone by densitometry revealed no statistically significant differences at each time interval among the 3 groups except for a decline in density in the control group after 6 months due to the bone remodelling process. The stability of the regenerated bone of the lengthened segment was best in the control group, with groups P and E showing marked changes in the length of the distracted distance.Conclusion: Although groups P and E exhibited slower new bone maturation, the amount of newly formed bone was equal in all groups. It could be stated that the periosteum and endosteum are probably not indispensable or particularly important for adequate callus formation. This may be due to the rich blood supply of the craniofacial skeleton. However the instability of the segment caused by the slow maturation and remodelling of the newly formed bone in groups P and E should be noted, and a longer consolidation period is recommended to avoid instability of the regenerated segment in such cases.

Effect of distraction osteogenesis on the severely hypoplastic mandible and inferior alveolar nerve function

Purpose The purpose of this study was to examine the effect of distraction osteogenesis surgery on the inferior alveolar nerve (IAN) and on the stability of the occlusion in patients undergoing mandibular osteotomy and advancement for correction of severe retrognathia. Materials and methods Five patients (4 women and 1 man) underwent vertical posterior body osteotomy or bilateral sagittal split ramus osteotomy with the application of a distraction device for advancement of the mandible of 10 to 14 mm. After a period of latency, each mandible was advanced 1 mm per day until the patient achieved a Class I occlusion. Distraction devices were removed after a suitable period of consolidation (4 to 11 months). IAN sensory function was evaluated by 2-point discrimination, response to painful stimulus, and moving brush stroke identification. Testing of the IAN was performed on all patients at 7 different time intervals: preoperative (T0), postsurgery and predistraction (T1), within 7 days after the end of distraction (T2), 3 months after T2 (T3), 6 months after T2 (T4), 9 months after T2 (T5), and 1 year after T2 (T6). The same surgeon performed all IAN testing. Results There were no instances of malunion or fibrous union. At the 1-year follow-up, all 5 patients showed no relapse of their advancement as assessed by their maintenance of a Class I occlusion. Radiographic analysis was not done to discern skeletal versus dental stability. All 10 IANs were intact after the initial surgery. As time progressed, all 10 nerves showed improvement of function as measured by 2-point discrimination, response to painful stimulus, and moving brush stroke identification. At 1 year postsurgery, all 10 nerves showed function consistent with or very near presurgery levels. Conclusion Stable mandibular advancements of 10 mm and greater can be successfully accomplished by distraction osteogenesis without producing significant damage to the IAN.

顎関節症を伴った下顎後退症に対しＰｒｏｇｒｅｓｓｉｖｅ ｃｏｎｄｙｌａｒ ｒｅｓｏｒｐｔｉｏｎの発現を制御すべく骨延長術を行った１例

Progressive condylar resorption (PCR) has been identified as a major problems in the outcome of orthognathic surgery. In order to prevent postoperative PCR, a patient with severe retromandible underwent mandibular lengthening using distraction osteogenesis with intraoral devices. An occlusal splint was simultaneously used during the distraction and consolidation period for the management.The patient was a 27-year-old female. Mandibular body osteotomy was performed in the angle region. The vector of distraction was parallel to the occlusal plane. The latency period was 7 days. The distraction rate was 0.8mm/day (0.4mm twice daily) for 18 days and the mandible was lengthened approximately 14mm in total. After 30 days of stabilization, the intraoral devices were removed. Enough osteogenesis was confirmed, and Le fort I type osteotomy and genioplasty were performed. Post-operative PCR has not manifested so far. Clinical and radiographic examination revealed no marked changes in the occlusion and profile at 14 months after distraction.

An ex vivo mechanical evaluation of single versus double semitubular plate fixation of a transverse distal-third scapular osteotomy in the dog.

To compare single versus double semitubular plate fixation for scapular body fractures. Ex vivo mechanical study. Eighteen paired cadaveric canine scapulae. Transverse scapular body osteotomies were created in the distal third of 18 pairs of scapulae. One scapula of each pair was repaired with a single plate, whereas the contralateral scapula was repaired with 2 plates. Initial strength and stiffness of the constructs were measured in 10 pairs of scapulae. Eight pairs of scapulae underwent cyclic loading and then were subjected to failure testing. Double-plate fixation was significantly stronger (3,899 +/- 632 N) but not stiffer (614 +/- 130 N/mm) than the single-plate fixation (3,238 +/- 935 N and 537 +/- 202 N/mm, respectively). Cyclic loading variables were not significantly different between the 2 methods of fixation. After cyclic loading, double-plate fixation was significantly stronger (2,916 +/- 618 N) than single-plate fixation (2,347 +/- 495 N). There was no significant difference (P =.11) in stiffness between double- versus single-plate fixations: 734 +/- 247 N/mm and 595 +/- 139 N/mm, respectively. Double-plate fixation was generally stronger and stiffer than single-plate fixation. Because all constructs failed at loads that greatly exceeded those estimated to occur clinically, any difference between the 2 methods of fixation probably is not clinically relevant. Single-plate fixation may be of sufficient strength for fixation of scapular body fractures.

Effect of electrical stimulation on mandibular distraction osteogenesis

This study was designed to examine whether the use of electrical stimulation during mandibular lengthening accelerates new bone formation.Twenty adult female rabbits weighing between 2800 g and 3200 g underwent left mandibular body osteotomy. After a 3 day latency period, an external fixation device was activated at a rate of 0.7 mm per day for 10 days. Direct current electrical stimulation of 10 μA was applied to 10 rabbit mandibles. Two of the screws were used as electrodes during the distraction phase. The other 10 rabbits (control group) were not stimulated. The device was then stabilized for periods of 10, 20, 30 and 60 days in both groups. The distraction segment was evaluated radiographically by assessing the proportion of bone mineral density using a dichroma scan. The amount of new bone formation was studied histologically with an image analyzer to evaluate the bone formation in the distraction gap.Histological examination showed that the new bone formation 10 and 20 days after distraction was greater in the electrical stimulation group than in the control group. Ten and 20 days after distraction, image analysis and analysis of bone mineral density in areas of newly formed bone indicated that there was a greater amount of new bone formation in the stimulation group than in the control group. The radiographic evaluation, however, did not demonstrate significantly different images between the stimulation group and the control group. Thirty and 60 days after distraction, no difference in the amount of new bone formation was noted in either the experimental or the control groups. These results indicate that electrical stimulation during gradual distraction promotes new bone formation in the early retention period in a rabbit model.

Condylar changes after contralateral mandibular osteotomy in the rabbit

Following orthognathic surgery undesirable changes in the temporomandibular joints (TMJs) are noted sometimes. Altered stress on the condyle and surrounding tissue frequently causes morphological changes in the TMJ. The purpose of the present study was to assess these morphologic changes in a rabbit following mandibular osteotomy and the resulting mandibular body rotation. Adult male Japanese white rabbits (3 kg, 12–16 weeks old) were applied in this study. An experimental mandibular osteotomy was performed on the right side of the body of the mandible. The surgery includes vertical mandibular body osteotomy 5 mm in width after masseter muscle reflection. Then the anterior and posterior osseous segments were fixed with wire at previously made holes. As a result, the condylar medio-lateral width on the contralateral (left) side was significantly larger than that of the ipsilateral side 2 weeks postoperatively (p<0;0.05). There were significant differences in the angle between the right and the left condylar heads 4 weeks postoperatively (p<0.05). The present experimental study demonstrated morphological changes in the contralateral TMJ caused by unilateral mandibular osteotomy. Postoperative morphological changes implied that there is a process of biological adaptation in the rabbit TMJ.

Posterior vertical body osteotomy (PVBO): A predictable rescue procedure for proximal segment fracture during sagittal split ramus osteotomy of the mandible

One of the more common complications of the bilateral sagittal split osteotomy of the mandible is proximal segment fracture (Fig 1). In a study by Behrman,’ proximal segment fracture was found to be the fourth most common complication of the sagittal split technique, occurring in approximately 3% of the cases reviewed. Turvey2 also found a 3% incidence of proximal segment fracture in his study. However, Macintosh’ found a 6.6% incidence of proximal segment fracture during sagittal split osteotomy. Clearly, buccal segment fractures occur with relative frequency even in the hands of the experienced surgeon. Therefore, knowledge of recovery, or so-called rescue, maneuvers should be a part of the orthognathic surgeon’s armamentarium. In this report, we describe one such maneuver not previously described in the literature. There are several options open to the surgeon in the event of a proximal segment fracture. The first, and arguably the best, is completion of the existing osteotomy. Once accomplished, the fractured proximal segment can usually be secured to the distal segment using bicortical screws or wire osteosynthesis at the inferior border of the mandible. However, completion of the osteotomy may not always be possible because of proximity of the inferior alveolar nerve or other technical difficulties. Another possibility for treatment of proximal segment fracture is horizontal osteotomy of the mandibu-

Fixation of mandibular body osteotomies using biodegradable amorphous self-reinforced (70L:30DL) polylactide or metal lag screws: an experimental study in sheep

Mandibular body osteotomies were fixed in nine sheep using new totally amorphous (70L:30DL), self-reinforced, polylactide (SR-PLA) lag screws and in nine sheep using standard stainless steel lag screws. No intermaxillary fixation was used. During follow-up, radiological, histological and microradiological studies were undertaken at 3, 6, 12 and 24 weeks. In both groups, all osteotomies consolidated at similar rates and no adverse reaction to the screws was seen. However, displacements of the fixed osteotomy fragments were common in both groups during the first 3 weeks. The biocompatibility of SR-PLA during the follow-up period was found to be good. Only initial signs of biodegradation were seen. The results of this study indicate that (70L:30DL) SR-PLA has potential for use as a fixation screw material in oral and maxillofacial surgery, and that further studies using this material are justified.

大阪歯科大学口腔外科学第２講座における１１年間の顎矯正手術の臨床統計的観察

Orthognathic surgery was performed on 362 patients from 1987 to 1997 at the Second Department of Oral and Maxillofacial Surgery, Osaka Dental University.The results were as follows: 1. The male-female ratio was 1: 2.4.2. The mean age was 22.4 years old.3. The diagnosis of mandibular prognathism was made for most of the patients (89.2%).4. Sagittal splitting ramus osteotomy (SSRO) was performed on 274 cases (75.7%).5. The mean time of operation for SSRO was 3hr. 7 min±57min, and for mandibular body osteotomy was 3hr. 15min±60.7min.6. The mean blood loss during operation for SSRO was 275.8±221.4ml and for mandibular body osteotomy was 171.8±147.5ml.7. Paresthesia of the lip and mental area was observed in 404 sides after opration. 80.7% of patients treated for SSRO recovered within a year.8. TMJ were examined in 202 cases for 1 year after SSRO. The symptom of TMJ was recognized in 5 cases.

Mandibular osteotomy fixed with biodegradable plates and screws: an animal study

The objective of the study was to evaluate the use of a totally biodegradable fixation device in the fixation of mandibular osteotomy in sheep. Mandibular unilateral body osteotomies were fixed with biodegradable self-reinforced poly-L-lactide (SR-PLLA) multi-layer plates and screws in nine sheep. The unoperated sides acted as control. The follow-up times were 6, 12 and 24 weeks, after which radiological, mechanical and histological studies were carried out. An analysis of the implanted material was also carried out. The results showed that the SR-PLLA plates and screws were strong enough to fix the osteotomy and that the osteotomies healed mainly with callus formation. Therefore we conclude that SR-PLLA multi-layer plates and screws can be used together successfully in the fixation of mandibular osteotomies without maxillomandibular fixation. However, before they can be used in humans, the size of the plate and screws should be decreased.

Variations in the correction of Treacher Collins syndrome.

A new combination of basically known techniques is described for the correction of Treacher Collins syndrome. The patients are treated in two to three operative sessions beginning early in the second decade of life. The main components are a chin advancement simultaneously with malar osteotomies in a first operation. In the second operation, the chin prominence is moved further forward by a simultaneous vertical movement of the maxilla, sagittal split osteotomy and body osteotomy of the mandible, together with a further chin advancement. Additional finishing touches may ask for a third intervention. Since there is a large variability of expression of the different signs, the techniques have to allow for a good deal of flexibility. The study of 10 patients reflects the considerable variations in the condition at the outset and the adequacy of the basic treatment protocol. The results of malar osteotomies are better than those of pure onlay augmentation. Despite the complexity of the maxillomandibular osteotomies, occlusal results are reasonably stable, and aesthetic improvement is considerable. The adaptation of the treatment to the individual patient resulted in modifications of direction of movement for different segments but also in omission of parts of the standard osteotomies. As a consequence, a modified treatment plan will be used as often as the standard program. The causes for the two not satisfying results are explained, and they demonstrate the limitations of the concept.

Comparison of absorbable self-reinforced multilayer poly-1-lactide and metallic plates for the fixation of mandibular body osteotomies: An experimental study in sheep

Eighteen unfavorable transverse osteotomies were created in the mandibular body of sheep. Nine were fixed with self-reinforced poly-1-lactide and nine with metallic dynamic compression plates. Both plates were fixed with similar titanium screws. The follow-up times for radiographic, histologic, and microradiographic studies were 6, 12, and 24 weeks. With both methods, bony union with callus formation was accomplished by 6 weeks in all but one osteotomy in the metallic fixation group. There were no signs of plate failure.

The Application and Problems of the Mandibular Body Osteotomy

The mandibular body osteotomy operation has become unpopular recently with the development of the mandibular ramus osteotomy. However, there were several cases which seemed to be an indication of this operation.In this paper, a successful surgical-orthodontic case with the mandibular body osteotomy was reported and its associated problems were discussed.A twenty year and five month old man showed mandibular prognathism with anterior open bite due to a large and clockwise rotated mandibular body. The body osteotomy was performed in the space of the first molar extraction. The mandibular arch width was adjusted in pre-surgical orthodontic treatment by the lingual arch appliance. It took two years and three months for the total active treatment and one year for retention. The treatment was finished successfully and followed up for eight months after retention.Through this case, we reconfirmed the usefulness of the body osteotomy in the case of mandibular prognathism with the poor molar condition. By careful maintenance of the excision space, prevention of injurying adjacent teeth and the neurovascular bundle and also comprehensive periodontal care after surgery, we had a stable result with the mandibular body osteotomy.