title: Modification of the sagittal split osteotomy of the mandibular ramus: mobilizing vertical osteotomy of the internal ramus segment.
abstract: OBJECTIVE
  We describe a new surgical procedure to improve stability when counterclockwise rotation of the maxillomandibular complex and the occlusal plane is intended.
  
  
  METHODS
  This preliminary prospective study evaluated 10 patients (8 female patients and 2 male patients) who each underwent maxillomandibular surgical advancement with counterclockwise rotation of the occlusal plane. A mandibular counterclockwise rotation was done in all cases with bilateral ramus sagittal split osteotomy. After the split of the ramus had been completed, a vertical osteotomy was done distally to the second molar on the internal ramus segment. With the completion of this vertical osteotomy, the internal ramus segment became completely mobile. All osteotomies were stabilized with rigid internal fixation by use of plates with monocortical screws.
  
  
  RESULTS
  Ten patients have been treated with the "mobilizing vertical osteotomy of the internal ramus segment." The mean reduction of the occlusal plane angle was 10.1 degrees , showing a substantial counterclockwise rotation of the maxillomandibular complex. All patients had significant improvement of their facial balance. After a 1-year follow-up period, all cases but 1 showed very good stability of their occlusion and occlusal plane angle. An 11.4% relapse of the forward movement of the mandible was noted.
  
  
  CONCLUSIONS
  On the basis of this prospective study, we conclude that when performing a counterclockwise rotation of the maxillomandibular complex, the mobilizing vertical osteotomy of the internal ramus segment combined with the sagittal split osteotomy of the mandible potentially enhances the occlusal plane angle and occlusal stability after a 1-year period.
authors.affiliation: Chief of Service, Oral and Maxillofacial Surgery, Centre de santé et de services sociaux de Gatineau (Hull Hospital), Gatineau, Quebec, Canada. geoffroyricard@sympatico.ca
authors.forename: Daniel
authors.initials: D
authors.lastname: Ricard
authors.forename: Joël
authors.initials: J
authors.lastname: Ferri
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D002508:Cephalometry; D003724:Dental Arch / Q000601:surgery; D003766:Dental Occlusion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008310:Malocclusion / Q000601:surgery*; D008334:Mandible / Q000601:surgery*; D019186:Mandibular Advancement / Q000295:instrumentation / Q000379:methods; D008437:Maxilla / Q000601:surgery; D024343:Open Bite / Q000601:surgery; D010027:Osteotomy / Q000145:classification / Q000295:instrumentation / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods; D011446:Prospective Studies; D012008:Recurrence; D012399:Rotation; D014061:Tongue Habits; D016896:Treatment Outcome; D055815:Young Adult