The TSAR-osteotomy, a total subapical and ramus osteotomy: A technical note.

Area of Science:

• Oral and Maxillofacial Surgery
• Orthognathic Surgery
• Surgical Anatomy

Background:

• Class II dentofacial deformities with a pronounced chin present complex treatment challenges.
• Surgical correction often involves osteotomies to reposition the mandible.
• The total subapical and ramus (TSAR) osteotomy is an advanced technique for addressing these deformities.

Purpose of the Study:

• To provide a detailed, step-by-step technical presentation of the TSAR osteotomy.
• To illustrate the surgical approach and critical steps for successful execution.
• To highlight the importance of nerve protection during the procedure.

Main Methods:

• The TSAR osteotomy surgical approach is divided into three distinct parts.
• Part 1: Horizontal osteotomy at the ramus level.
• Parts 2 & 3: Corticotomy for mental nerve release and protection, connecting to the ramus osteotomy while actively protecting the inferior alveolar nerve (IAN).

Main Results:

• A clear, schematic presentation of the TSAR osteotomy procedure is provided.
• The technique emphasizes meticulous dissection and protection of vital neurovascular structures.
• Successful execution relies on careful identification and preservation of the inferior alveolar nerve (IAN).

Conclusions:

• The TSAR osteotomy is a viable surgical option for Class II dentofacial deformities with a pronounced chin.
• This technical note serves as a guide for surgeons performing the TSAR osteotomy.
• Prioritizing protection of the inferior alveolar nerve (IAN) is crucial for optimal patient outcomes.