Alternative Osteotomies in the Mandible

Vertical osteotomies in the ascending mandible are accessed via a transoral approach. The intraoral vertical ramus osteotomy (IVRO) is performed from the lateral mandibular side and should be located dorsal to the lingula on the lingual side in order not to injure the neurovascular bundle of the mandibular canal. If angulated saws, burrs or Piezo surgery are not available an extraoral approach must be considered. The inverted L-osteotomy represents another variant of vertical osteotomies in the ascending mandibular ramus. Inverted L and IVRO can also be used in bimaxillary surgery if anatomical reasons do not permit a BSSO. However, they are only considered practicable in bimaxillary surgery in exceptional situations and are not standard procedures. A longer period of intermaxillary fixation must be anticipated.