A Novel Instrument-based Technique to Identify the Mandibular Foramen during Sagittal Split Ramus Osteotomy

Sagittal split ramus osteotomy is a fundamental procedure in orthognathic surgery. Precise identification of the mandibular foramen is critical for achieving optimal splitting patterns and minimizing neurosensory deficits. Preoperative cone-beam computed tomography assessment is a current method for foramen identification; however, radiographic images do not represent the intraoperative anatomical conditions. Visual access interference and anatomical constraints from the internal oblique ridge make foramen identification challenging. To address this unmet need, we developed a specialized instrument, the mandibular foramen probe. This instrument features a spherical tip and laser markings on the shank. The shank is designed to be parallel to the occlusal plane once the probe is seated on the foramen. Our technique provides safe and precise guidance to bridge the gap between planning and surgical reality during sagittal split ramus osteotomy.