Medial Mandibular Angle as a Potential Donor Site in Orthognathic Surgery for Skeletal Class II Patient

This study proposes a novel approach for skeletal class II patients with insufficient maxillary and mandibular bone stock. During sagittal split ramus osteotomy, the medial aspect of the bilateral mandibular angles can serve as a donor site for interpositional bone grafting to fill the gap created by maxillary movement. Through preoperative digital design for 3D imaging analysis and surgical simulation, this technique eliminates the need for a secondary surgical site or bone substitutes, providing additional autogenous bone blocks to address the deficiency after Le Fort I advancement. Postoperative follow-up evaluated bone union, graft resorption, and midfacial contour. The free bone grafts achieved successful osseous integration with minimal resorption, maintaining stable volume and ensuring satisfactory midfacial projection. This method offers an effective autogenous bone grafting solution for class II patients, avoiding synthetic materials while achieving stable functional and aesthetic outcomes.