title: Anatomic study to determine a safe surgical reference point for mandibular ramus osteotomy.
abstract: OBJECTIVE
  The purpose of this study was to identify a surgical reference point on the mandibular ramus that can be used during ramus osteotomy to prevent injury to the inferior alveolar nerve.
  
  
  METHODS
  A total of 125 subjects' mandibles were analyzed and compared on a three-dimensional (3D) model constructed from computed tomography (CT). 25 volunteer subjects with normal class I occlusion (group I, control), 50 consecutive subjects (25 females and 25 males) diagnosed with mandibular retrognathism (group II), and 50 consecutive subjects (25 females and 25 males) with prognathism (group III) were included. This study created a landmark (the midwaist point) at the halfway point on a horizontal plane between the most concave points on the anterior and posterior borders of mandibular ramus, with the vertical plane bisecting the horizontal plane. The midwaist point was compared to other anatomic landmarks including antilingula, lingula, and mandibular foramen for correlation.
  
  
  RESULTS
  The distance from the midwaist point to lingula and mandibular foramen along the horizontal plane was not significantly different among three groups. Lingula and mandibular foramen were mostly located within 2 mm posterior of the midwaist point, whereas the locations of lingula and mandibular foramen along the vertical plane to the midwaist point were highly variable.
  
  
  CONCLUSIONS
  The midwaist point is an excellent intraoperative reference point that can help surgeons to identify the position of the lingual and the mandibular foramen, thus preventing inferior alveolar nerve injury.
authors: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
authors: Kyung-Ran
authors: KR
authors: Park
authors: Oral, Facial, and Dental Implant Surgery, Vienna, VA, USA.
authors: Sang-Yoon
authors: SY
authors: Kim
authors: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea; Wiz Orthognathic Clinic, Seoul, Republic of Korea.
authors: Gi-Jung
authors: GJ
authors: Kim
authors: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea; Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea.
authors: Hyung-Sik
authors: HS
authors: Park
authors: Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea; Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea. Electronic address: ysjoms@yuhs.ac.
authors: Young-Soo
authors: YS
authors: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D059925:Anatomic Landmarks / Q000033:anatomy & histology*; D002508:Cephalometry / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008334:Mandible / Q000033:anatomy & histology* / Q000601:surgery; D008340:Mandibular Nerve / Q000473:pathology; D063168:Mandibular Osteotomy / Q000379:methods*; D011378:Prognathism / Q000000981:diagnostic imaging; D063173:Retrognathia / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D061221:Trigeminal Nerve Injuries / Q000517:prevention & control; D055815:Young Adult
keywords: Computed tomography; Inferior alveolar nerve; Lingula; Mandibular foramen; Mandibular ramus; Ramus osteotomy