Combination of Mandibular Constriction and Intraoral Vertical Ramus Osteotomies for a Transverse Jaw Discrepancy

Abstract

Background:The aim of the present study was to evaluate the treatment of patients developing a transverse jaw width discrepancy who exhibited class III malocclusion and/or facial asymmetry by a combination of mandibular constriction (MC) and intraoral vertical ramus osteotomies (IVROs).Subjects and methods:In a retrospective study, functional results, postoperative complications, and skeletal stability were analyzed for all the patients who had undergone MC and IVRO, with more than 2 years of follow-up. A mandibular midline osteotomy for constriction with lag screw technique and IVROs was used for MC and setback.Results:Sixteen patients were included in the present study. The average degree of MC was 6.34 mm. Both the occlusal relationship and facial appearance in all patients were significantly improved by the surgical orthodontic treatment, with no harmful clinical symptoms. In addition, our original MC using lag screw technique provided the most reliable results in terms of skeletal stability.Conclusions:This study showed that MC using lag screw technique gives a very stable mandibular width constriction, and the combination of MC and IVROs offers a promising treatment alternative for patients with mandibular prognathism developing a transverse jaw width discrepancy.

Mandibular midline osteotomy for correction of bimaxillary transverse discrepancy: a technical note

“…In this study, the maxilla with adequate transverse width and constricted mandible having arch width discrepancy was indication for a surgical correction as described here. Although literature shows evidence that favours maxillary expansion via surgery or DO, it can prove to be more stressful for the patient than when bi-jaw surgery is performed 7 . As mentioned earlier, multi-piece segmental maxillary osteotomies carry the risk of a myriad of complications.…”

“…Though historically not a new technique, mandibular midline osteotomies have been employed to correct excess and discrepancies in the transverse dimension. When patients present with a normal maxilla and mandibular width excess, expansion of the maxilla is mostly preferred 7 . Hara et al 7 performed a mandibular width reduction by performing osteotomies at symphyseal and posterior mandibular regions in a bimaxillary discrepancy patient, having mandibular excess.…”

“…When patients present with a normal maxilla and mandibular width excess, expansion of the maxilla is mostly preferred 7 . Hara et al 7 performed a mandibular width reduction by performing osteotomies at symphyseal and posterior mandibular regions in a bimaxillary discrepancy patient, having mandibular excess. When the maxilla presents adequate transverse width or a mild width deficit that can be corrected with orthodontics, isolated mandibular surgery may be useful in adjustment of bimaxillary problems.…”

“…In bimaxillary discrepancies wherein a normal maxilla and an abnormal mandible are observed, the standard management approach is either a mandibular surgery or a multi-segmented maxillary transverse width variation 7 , 8 . In any case, the normal jaw with adequate dimensions should be preserved as such and any surgical correction must involve the affected jaw.…”