title: The modifications of the sagittal ramus split osteotomy: a literature review.
abstract: BACKGROUND
  In 1953, the sagittal ramus split osteotomy was introduced by Obwegeser. For many years, and in some countries still, this technique has defined the term oral and maxillofacial surgery.
  
  
  METHODS
  The basic design of the sagittal ramus split surgical procedure evolved very quickly. The original operation technique by Obwegeser was shortly after improved by Dal Pont's modification. The second major improvement of the basic technique was added by Hunsuck in 1967. Since then, the technical and biological procedure has been well defined. Resolution of the problems many surgeons encountered has, however, taken longer. Some of these problems, such as the unfavorable split or the damage of the inferior alveolar nerve, have not been satisfactorily resolved.
  
  
  RESULTS
  Further modifications, with or without the application of new instruments, have been introduced by Epker and Wolford, whose modification was recently elaborated by Böckmann. The addition of a fourth osteotomy at the inferior mandibular border in an in vitro experiment led to a significant reduction of the torque forces required for the mandibular split.
  
  
  CONCLUSIONS
  The literature was reviewed, and the last modifications of the successful traditional splitting procedure are presented narrowly. It indicates the better the split is preformatted by osteotomies, the less torque force is needed while splitting, giving more controle, a better predictability of the lingual fracture and maybe less neurosensory disturbances of the inferior alveolar nerve.
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Roland
authors.initials: R
authors.lastname: Böckmann
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Joeri
authors.initials: J
authors.lastname: Meyns
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Dik
authors.affiliation: Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Kessler