Modified sagittal split technique for patients with a high lingula

Unfavorable fractures of the proximal fragment during the sagittal ramus split procedure, although uncommon, occur with an incidence ranging between 3% and 6.6%. One anatomic feature that may predispose to an unfavorable fracture is a thin mandibular ramus in the region of the medial osteotomy. One particular situation that can increase the risk of an unfavorable fracture is a lingula that is situated very high on the mandibular ramus. Even in a normal-sized mandibular ramus, a high lingula places the medial cut in a thin region where there is little or no cancellous bone. The technique presented is a modification of the sagittal split osteotomy which can assist the surgeon in preventing an unfavorable fracture should an unusually high lingula or a thin ramus be encountered.