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A Novel Intraoral Mandibular Osteotomy For Set-Back Surgery In Complex Mandibular Anatomy.

Mohammed Omara¹, Sherif Ali², Yassin Salah Alian³

¹Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, 11 Saraya Street, Manial, Cairo, Egypt. mohammed.omara@dentistry.cu.edu.eg.

Clinical Oral Investigations

|March 28, 2025

Summary

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This study introduces a modified Inverted-L Ramus Osteotomy (ILRO) for complex mandibular setback surgery, improving safety and outcomes for patients with challenging anatomy. The technique effectively manages anatomical variations while protecting the inferior alveolar nerve (IAN).

Area of Science:

Oral and Maxillofacial Surgery
Orthognathic Surgery
Anatomical Variations Management

Background:

Complex mandibular anatomy presents challenges for traditional osteotomies.
Rolled-out inferior borders and thin rami with adherent inferior alveolar nerves (IAN) complicate mandibular setback surgery.

Purpose of the Study:

To introduce a modified intraoral Inverted-L Ramus Osteotomy (ILRO).
To manage complex mandibular anatomical variations during mandibular setback surgery.
To enhance inferior alveolar nerve (IAN) protection and segment integrity.

Main Methods:

Prospective study of 20 skeletal class III patients undergoing mandibular setback surgery.
Utilized modified ILRO with IAN lateralization and intra-canal osteotomy.

Keywords:

Angle class III Inferior alveolar nerve injuries Intraoperative complications Orthognathic surgery Prognathism Surgery, computer-assisted

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Preoperative CBCT imaging, digital planning, and surgical guides were employed.

Main Results:

Mean surgical duration was 2.26 hours; bilateral IAN exposure averaged 11 minutes per side.
All 40 osteotomy sites were successfully separated without bad splits.
Inferior alveolar nerve (IAN) neurosensory deficits decreased from 90% at two months to 5% at one year.

Conclusions:

The modified ILRO effectively addresses limitations of traditional osteotomies in complex mandibular anatomy.
This technique ensures adequate IAN protection and maintains split segment integrity.
The ILRO offers a safe alternative for mandibular setback surgery.