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Two-thirds anteroposterior ramus length is the preferred osteotomy point for intraoral vertical ramus osteotomy

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Abstract

Objectives

This study aimed to investigate the mandibular canal of ramus and design a suitable osteotomy line for intraoral vertical ramus osteotomy (IVRO) using cone-beam computed tomography (CBCT).

Materials and methods

Ninety patients were classified into class I, II, and III skeletal pattern groups. When extended from the horizontal base plane (0 mm, mandibular foramen [MF]), with a 2-mm section interval, to 10 mm above and 10 mm below the MF, the following landmarks were identified: external oblique ridge (EOR), posterior border of the ramus (PBR), and posterior lateral cortex of ramus (PLC): IVRO osteotomy point.

Results

In the base plane (0-mm plane), the EOR-PBR distance of class III (34.78 mm) and the IOR-PBR distance of class II (32.72 mm) were significantly higher than those of class I (32.95 mm and 30.03 mm). Compared to the EOR-PLC distance, the designed osteotomy point (two-thirds EOR-PBR length) has a 3.49-mm safe zone at the base plane and ranging from 0.89 mm (+ 10-mm plane) to 8.37 mm (− 10-mm plane).

Conclusions

The position at two-thirds EOR-PBR length (anteroposterior diameter of the ramus) can serve as a reference distance for the IVRO osteotomy position.

Clinical relevance

Mandibular setback operations for treating mandibular prognathism mainly include sagittal split ramus osteotomy (SSRO) and IVRO. IVRO has a markedly lower incidence of postoperative lower lip paraesthesia than SSRO. Our design presented a reference point for identification during IVRO, to prevent damage to the inferior alveolar neurovascular bundle.

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Acknowledgements

The authors would like to thank Ying-Chun Lin, assistant research fellow, of the Department of Dentistry, Kaohsiung Medical University Hospital for editing assistance.

Funding

The present study was funded by the authors’ own institution.

Author information

Author notes

  1. Chun-Ming Chen and Han-Jen Hsu contributed equally to this work.

Authors and Affiliations

  1. School of Dentistry and Graduate Program of Dental Science, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chun-Ming Chen, Shih-Wei Liang, Ping-Ho Chen, Kun-Jung Hsu & Yu-Chuan Tseng

  2. Division of Oral and Maxillofacial Surgery, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

    Chun-Ming Chen & Han-Jen Hsu

  3. Department of Dentistry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Kun-Jung Hsu

  4. Division of Orthodontics, Department of Dentistry , Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan

    Yu-Chuan Tseng

Authors
  1. Chun-Ming Chen
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  2. Han-Jen Hsu
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  3. Shih-Wei Liang
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  4. Ping-Ho Chen
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Corresponding author

Correspondence to Yu-Chuan Tseng.

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Ethical approval

The retrospective study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital, Taiwan (KMUH-IRB 20160066).

Informed consent

Informed consent signed by the patients was waived because of the observational nature of the study and the anonymity and deidentification of personal information before data analysis.

Conflict of interest

The authors declare no competing interests.

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Chen, CM., Hsu, HJ., Liang, SW. et al. Two-thirds anteroposterior ramus length is the preferred osteotomy point for intraoral vertical ramus osteotomy. Clin Oral Invest 26, 1229–1239 (2022). https://doi.org/10.1007/s00784-021-04094-1

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  • DOI: https://doi.org/10.1007/s00784-021-04094-1

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