Intraoral oblique osteotomy of the ascending mandibular ramus

Surgical correction of mandibular deformity by orthognathic ascending branch oblique osteotomy. Curing disease: Indication Oral mandibular ascending branch oblique osteotomy is applicable to: 1. Mandibular anterior deformity with overdevelopment of the dental arch, requiring both to retreat at the same time to correct the deformity recovery function. 2. The long neck of one of the condyles is too long to cause an asymmetrical mandibular protrusion. 3. Slightly shorten the length of the mandibular ascending branch. 4. Combined with other surgical procedures to correct the complicated dental mandibular deformity with mandibular protrusion. Contraindications The occlusal relationship is normal, only the ankle development is too large; the molar relationship between the molars is normal, and only the anterior arch development is too large for the operation. Preoperative preparation 1. Complete the necessary preoperative correction and leave a fixed appliance with a hook between the jaws. 2. The X-ray skull is used to position the lateral slice for measurement, and the simulated surgery is used to perform the cutting movement to provide the osteotomy site, the moving distance and the direction, and predict the postoperative effect. Surgical procedure Incision 1.0cm above the occlusal surface of the mandibular molar, along the leading edge of the ascending branch and the external oblique sac, as a mucosal incision, extending outward to the distal cheek of the first molar, the incision reaching the bone surface. 2. Reveal the lateral surface of the ascending branch Extensive separation of the diaphragm and the masseter muscle area was performed under the periosteum with a stripper to fully reveal the ascending branch leading edge, the lateral bone surface, the sigmoid notch, and the condylar neck. However, the soft tissue at the trailing edge and inner side of the ascending branch is not separated. The ascending retractor is placed and fitted to the posterior edge of the ascending branch to draw, secure, and protect the soft tissue. 3. Oblique osteotomy There are two types of osteotomy lines. The low oblique osteotomy line is from the midpoint of the sigmoid notch to the mandibular angle; the high oblique oblique osteotomy line is from the midpoint of the sigmoid notch to the midpoint of the posterior margin of the ascending branch, which is equivalent to the posterior margin of the condyle. Extension cord. The inner and outer bone plates were simultaneously cut with an electric long-handled fan-shaped oscillating saw according to the designed osteotomy line. The separator is used to guide the proximal bone piece to the outside so as to overlap the outer side of the distal piece. The inner wing of the lower edge of the proximal bone plate is attached to the inner wing of the pterygoid, the overlapping part is peeled off, and the muscle behind is retained. 4. According to the same method, the contralateral ascending branch is applied. 5. Mandibular retreat, reconstruction occlusion The jaw plate was worn into the maxillary teeth, and the mandible was retracted after the ascending branch was disengaged to reach the occlusal relationship recorded by the jaw plate. 6. Fixation and suturing The bone between the two ends can be fixed. After confirming the reconstruction of the occlusal relationship, the condyle is located in the joint socket, and the proximal bone piece overlaps the outer side of the distal bone piece to perform intermaxillary fixation. complication 1. Injury of the inferior alveolar nerve causes numbness of the hemilateral teeth and lower lip. 2. Temporomandibular joint dysfunction occurred after transposition of the condyle.