New appliance for repositioning the proximal segment during rigid fixation of the sagittal split ramus osteotomy

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Rigid fixation with plates or screws has been widely favored following sagittal split ramus osteotomy of the mandible. Its advantages include early recovery of jaw function, rapid bone healing, and decreased potential for relapse. However, when improper positioning of the proximal segment occurs during the fixation procedure, various problems can result, including limitation of mouth opening, pain and/or clicking in the temporomandibular joint, and skeletal relapse. To avoid these problems, a number of methods have been proposed to maintain the original position of the proximal segment. These methods are based on the use of a standard point that does not change before and after splitting of the mandible. For this point, the zygoma’.’ or maxillary teeth3-6 are usually chosen. The advantage of choosing the zygoma as a standard point is that it is available even in two-jaw surgery. The disadvantage is that adjustment of a miniplate extending from the zygoma to the proximal segment is time consuming3 because of the complicated contour of the zygoma and ramus. Alternatively, choice of the maxillary teeth as a standard point has the disadvantage of being fairly unstable, and the procedure can affect the orthodontic appliance. We have, therefore, developed a new appliance that uses the alveolus and teeth as the standard point.

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