Technique for intraoral inverted ‘L’ osteotomy

Facilitating ramus lengthening following mandibular-dependent surgical closing of a skeletal open bite with short ramus: A new modified technique

“…Applications in setback as well as advancement cases were published (McMillan et al, 1999;Muto et al, 2008).…”

Mapping the Mandibular Lingula in Pierre Robin Sequence

“…Risk of nerve injury has been attributed manipulation of the nerve during drilling, compression during rigid fixation, overstretching during traction, medial periosteal dissection, magnitude of mandibular movement, and width of marrow space between the mandibular canal and the external cortical bone. [4][5][6][7][8][9][10] Furthermore, tooth root injury can occur during osteotomy, placement of screws/pins, or application of distraction forces, potentially causing changes in the mandibular molars, destruction of tooth follicles, altered dental development, long-term tooth loss, and dentigerous cyst formation. [11][12][13] In comparison, proponents of the inverted-L ramus osteotomy (ILRO), first described in 1927 by Wassmund, 10,14,15 and subsequently modified by others, [16][17][18][19][20] have championed the technique for avoiding injury to tooth roots and the inferior alveolar nerve.…”

“…[4][5][6][7][8][9][10] Furthermore, tooth root injury can occur during osteotomy, placement of screws/pins, or application of distraction forces, potentially causing changes in the mandibular molars, destruction of tooth follicles, altered dental development, long-term tooth loss, and dentigerous cyst formation. [11][12][13] In comparison, proponents of the inverted-L ramus osteotomy (ILRO), first described in 1927 by Wassmund, 10,14,15 and subsequently modified by others, [16][17][18][19][20] have championed the technique for avoiding injury to tooth roots and the inferior alveolar nerve. 19,[21][22][23] Furthermore, other advantages of the ILRO 21 include increased posterior facial height, 24 preserved position and retained balance of masticatory muscles, 23 and increased osseous stabilization.…”

“…1), with the inferior alveolar nerve under direct vision. 10,23 This technique places the cut line higher in the ramus and avoids splitting of the tooth follicle. 12,26 Furthermore, since it does not require a sagittal split, the ILRO aims to obviate the risk of compromising the inferior alveolar nerve, especially in cases with challenging anatomy.…”

“…17 Nonetheless, the risk of iatrogenic nerve injury is not definitively eliminated. 10,27 The lingula is a tongue-shaped bony projection on the internal surface of the ramus that reliably heralds the mandibular foramen and associated inferior alveolar nerve ( Fig. 2A).…”