Minimally invasive orthognathic surgery: endoscopic vertical ramus osteotomy

Area of Science:

• Oral and Maxillofacial Surgery
• Minimally Invasive Surgical Techniques
• Anatomical Dissection

Background:

• Endoscopic mandibular advancement has been previously documented.
• Mandibular setback procedures are crucial for correcting skeletal discrepancies.
• Minimally invasive approaches are sought to reduce surgical morbidity.

Purpose of the Study:

• To demonstrate the feasibility of an endoscopic approach for mandibular setback.
• To evaluate the technique of endoscopic exposure, dissection, and osteotomy for mandibular set-back.
• To assess the viability of the endoscopic extraoral vertical ramus osteotomy (EVRO) procedure in a preclinical model.

Main Methods:

• Utilized two cadavers and three anesthetized minipigs.
• Achieved mandibular ramus access via a 2.0 cm submandibular incision.
• Employed a 2.7 mm endoscope for visualization and performed bilateral vertical ramus osteotomies.
• Set back the mandible an average of 6 mm and fixed with bicortical screws.

Main Results:

• Successfully achieved endoscopic exposure, landmark identification, osteotomy, and screw fixation in all specimens.
• Demonstrated clinical and radiographic evidence of bone union in live animals three weeks postoperatively.
• Confirmed the feasibility of the EVRO procedure for mandibular setback in the minipig model.

Conclusions:

• The endoscopic extraoral vertical ramus osteotomy (EVRO) is a feasible technique for mandibular setback.
• This minimally invasive approach allows for accurate osteotomy and stable fixation.
• The minipig model serves as a viable platform for further research into endoscopic mandibular reconstruction techniques.