Experience with the sagittal osteotomy of the mandibular ramus: a 13-year review

This report surveys the experience in 236 patients operated on by the author, of whom 155 provided records complete enough to provide information on all the elements of postoperative evaluation. Patients were evaluated at a minimum of 2 years after surgery. The patients had an average age of 23 years, and were predominantly female in a ratio of more than 4:1. No intraoperative or postoperative physiologically threatening problems as elsewhere described in the literature, such as profound blood loss, airway obstruction, or gross loss of bone substance, were encountered. An immediate postoperative paraesthesia incidence of almost 85% was observed, which diminished to 9% 1 year postoperatively. The prolonged paraesthesia were most common in patients over 40 years of age; similarly, healing was prolonged in patients over 40, prompting the author's recommendation that 8 weeks intermaxillary fixation rather than 6 be employed in these patients. The overall relapse rate was approximately 30%; this was clinically significant in approximately 12% of patients, and required reoperation in 4 patients. Relapse was most marked in apertognathic patients, demonstrating, in the author's opinion, that the sagittal ramus osteotomy should not be used, in general, in open-bite cases. The particulars of the technique and the author's views on regression are presented.