Transoral vertical ramus osteotomy fixed with Kirschner pins.

Area of Science:

• Oral and Maxillofacial Surgery
• Orthognathic Surgery
• Surgical Techniques

Background:

• Transoral vertical ramus osteotomy (VRO) has faced criticism due to concerns about condylar sagging and prolonged maxillomandibular fixation.
• Traditional VRO methods often require extensive fixation periods, potentially leading to patient discomfort and increased risks.

Purpose of the Study:

• To introduce and evaluate a novel, simple fixation method for transoral vertical ramus osteotomy (VRO).
• To assess the effectiveness and complication profile of this new K-pin fixation technique in a patient cohort.

Main Methods:

• A modified VRO technique involving trimming of osteotomy segments for adaptation.
• Percutaneous insertion of four 0.9mm Kirschner (K) pins from proximal to distal segments to stabilize the condyle in the glenoid fossa.
• A brief period of maxillomandibular fixation following K-pin placement.

Main Results:

• The K-pin fixation method was reviewed in 95 patients undergoing VRO, with a mean fixation duration of 19 days.
• Fixation stability was achieved in all but two patients, with successful outcomes in 20 dual-jaw procedures.
• Mean maximal mouth opening at follow-up was 44 mm, with minimal reported complications such as temporary lip/chin numbness or pin site discomfort.

Conclusions:

• The simplified K-pin fixation method for transoral vertical ramus osteotomy (VRO) is effective and associated with a low complication rate.
• This technique offers a viable alternative to traditional fixation methods, allowing for shorter fixation periods and good functional recovery.
• Further evaluation within its specific limitations is warranted for broader clinical application.