Combination of intraoral inverted L ramus and sagittal splitting ramus osteotomy for mandibular asymmetry

Abstract

When severe mandibular asymmetry is corrected by sagittal splitting ramus osteotomy (SSRO), the distal bone fragment pushes the proximal bone fragment on the side of deviation. In some patients, temporomandibular joint dysfunction (TMD) is caused by rotation of mandibular condyle. Although intraoral vertical ramus osteotomy has the advantage of correcting mandibular asymmetry, long-term intermaxillary fixation (IMF) is necessary, because rigid fixation is impractical. Various other complicated methods are used for operation, but a simple procedure and a short duration of IMF are preferred.
We used intraoral inverted L ramus osteotomy with SSRO to correct 14 cases of mandibular asymmetry. All patients had good facial symmetry. This procedure was able to decrease the rotation of the condyle on the side of deviation, and semirigid fixation with a miniplate was possible. Consequently, no patient had TMD postoperatively, and the duration of IMF was shortened.