Pearls and Pitfalls of the Intraoral Vertical Osteotomy

The vertical ramus osteotomy was originally developed at Walter Reed Medical Center by Jack Caldwell and George Letterman in 1954.2 It was initially performed from an extraoral approach and used to treat mandibular prognathism. Its novelty was that it was an osteotomy that minimized injury to the mandibular nerve. In 1970, Jon Kent and Ed Hinds (from the University of Texas—Houston) designed an intraoral 90-degree saw to osteotomize the ascending ramus of the mandible from a purely intraoral approach. During the 1970s and 1980s, David Hall (from Vanderbilt University) further refined the VRO procedure and demonstrated that it could treat mandibular prognathism and mild mandibular retrognathia (advancement of 2 mm or less). In addition, Hall and McKenna championed VRO as a treatment for temporomandibular joint dysfunction. The purpose of this chapter is to review the pearls and pitfalls of intraoral vertical osteotomy.