The Sagittal Splitting of the Mandible Procedure

Abstract

I have often been asked how I conceived the idea of the sagittal splitting procedure on the mandibular ascending rami. The story is as follows: I started my training in maxillofacial surgery in 1947 with my teacher Richard Trauner at the Maxillofacial Unit of the Dental School of the University of Graz, Austria. At that time orthognathic surgery was almost non-existent with the exception of the occasional correction of a then so-called prognathism case. The Kostecka procedure was used, with the patient sitting in a dental chair. Before surgery he had received some sedation, premedication then local infiltration and block anaesthesia. An assistant held the patient’s head steady. With the help of a large curved awl, a strong thread was pulled around the lingual side of the mandible, above the lingula. To that thread a Gigli saw was fixed and pulled through the soft tissues and the covering skin. With that Gigli saw the ascending ramus was cut. It took just 15 min or less to cut both sides. Then the jaw was immobilized by intermaxillary fixation for 6–8 weeks in the preplanned and prepared occlusion.