Modified Mandibular Sagittal Split Osteotomy

Mandibular osteotomies aim to displace the dental arch to the necessary position, ideally without limitation, while preserving inferior alveolar nerve (IAN) function. Supraforaminal osteotomies offer nerve safety but limit the extent of advancement, whereas Epker and Obwegeser-Dal Pont osteotomies enable unchallenged mandibular advancement but are associated with an inferior border notch. Here, we describe a new technique to avoid such disadvantages.

The beginning of the procedure was similar to Epker's technique, with sectioning of the lingual cortex up to the level of the lingula. Sectioning of the buccal cortex was stopped 3 to 4 mm above the inferior border and then performed horizontally up to the gonial angle in total thickness. The inferior border periosteum and muscles attachments were conserved and hence, appropriately vascularized.

This technique offers 4 advantages: absence of the inferior border notch, lower risk of damage to the IAN than with Epker's technique, sufficiently large bony surface to obtain bone healing as in Epker's technique, and no limitation to setback movement in contrast to Obwegeser-Dal Pont's or the supraforaminal osteotomy techniques.