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    Inverted L Osteotomy

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    haneefmdf
    The inverted-L osteotomy is a surgical technique used to correct mandibular prognathism or asymmetries through small or large setbacks, ramus lengthening, or mandibular advancements. It involves making a horizontal cut just above the mandibular foramen followed by a vertical cut along the lateral ramus. This allows repositioning of the mandibular segment while keeping the coronoid process and temporalis muscle in their original position. Bone or synthetic grafts are often required for significant advancements or lengthening. Rigid fixation is then used to stabilize the segments during healing.

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    Inverted L Osteotomy

    Uploaded by

    haneefmdf
    320 views9 pages
    The inverted-L osteotomy is a surgical technique used to correct mandibular prognathism or asymmetries through small or large setbacks, ramus lengthening, or mandibular advancements. It involves making a horizontal cut just above the mandibular foramen followed by a vertical cut along the lateral ramus. This allows repositioning of the mandibular segment while keeping the coronoid process and temporalis muscle in their original position. Bone or synthetic grafts are often required for significant advancements or lengthening. Rigid fixation is then used to stabilize the segments during healing.

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    The inverted-L osteotomy is a surgical technique used to correct mandibular prognathism or asymmetries through small or large setbacks, ramus lengthening, or mandibular advancements. It involves making a horizontal cut just above the mandibular foramen followed by a vertical cut along the lateral ramus. This allows repositioning of the mandibular segment while keeping the coronoid process and temporalis muscle in their original position. Bone or synthetic grafts are often required for significant advancements or lengthening. Rigid fixation is then used to stabilize the segments during healing.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    320 views9 pages

    Inverted L Osteotomy

    Uploaded by

    haneefmdf
    The inverted-L osteotomy is a surgical technique used to correct mandibular prognathism or asymmetries through small or large setbacks, ramus lengthening, or mandibular advancements. It involves making a horizontal cut just above the mandibular foramen followed by a vertical cut along the lateral ramus. This allows repositioning of the mandibular segment while keeping the coronoid process and temporalis muscle in their original position. Bone or synthetic grafts are often required for significant advancements or lengthening. Rigid fixation is then used to stabilize the segments during healing.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 9

    Inverted-L Osteotomy

    Indications
    Small or large setbacks
    Asymmetries
    Mandibular
    advancements
    Ramus lengthening
    Thin ramus mediolaterally
    Severe decrease in
    posterior mandibular
    body height

    Contraindications
    Abnormal posterior
    location of the mandibular
    foramena
    Mandibular advancement
    without grafting

    Advantages
    Can correct mandibular prognathism or
    asymmetries
    Coronoid process and temporalis muscle
    remain basically in originally position
    Can setback mandible greater distance
    Can lengthen ramus or advance the
    mandible when used with bone or
    synthetic bone for grafting
    May be able to use rigid skeletal fixation

    Disadvantages
    Usually requires bone or synthetic bone
    grafting for significant ramus lengthening
    or mandibular advancement
    Healing time may be increased compared
    to other technique because of poor
    approximation of the segments when
    grafts are not used

    INTRAORAL SURGICAL TECHNIQUE


    The inverted-L osteotomy is a blend of the IVRO and
    SSRO techniques
    The medial exposure and dissection are done as for SSRO.
    The nerve is identified as it enters the mandibular foramen
    medially.
    With the medial soft tissues protected, the horizontal
    osteotomy is completed just superior to the foramen with
    either a reciprocating saw or a Lindemann bur.
    The bicortical horizontal osteotomy should be completed
    first, as close as possible to the mandibular foramen to
    minimize the chance of coronoid fracture, which would
    convert the inverted L into an IVRO with coronoidotomy.
    Exposure of the lateral ramus and completion of the inferior
    vertical osteotomy are exactly the same as for the IVRO.

    It is important to keep the medial osteotomy as close as possible to the mandibular


    foramen to avoid creating a coronoid fracture.

    Rigid fixation of the segments is performed with


    the patient in MMF.
    One or two percutaneous bone plates are used to
    secure the segments.
    As with SSRO, care in seating the condyle
    properly is essential. The plate is secured initially
    only to the condylar segment, where it can be
    used as a lever arm to assist in condylar seating.
    Then screws are placed in the distal segment to
    maintain the gap.
    Autogenous bone graft is then contoured to the
    appropriate dimension and secured snugly in
    position.

    If a second bone plate is used, it is then adapted and


    secured. Use of closed suction drains is strongly
    recommended to prevent hematoma formation following
    the soft tissue dissection and bone graft.
    Depending on the quality of the rigid fixation, the patient
    is maintained in MMF for 5 to 14 days after surgery.
    Elastic traction is used to guide the occlusion and
    resist soft tissue relapse for the next 4 to 5 weeks
    while initial bone healing occurs.
    If mandibular setback is performed, bony interference is
    eliminated to achieve passive segment approximation
    before placement of rigid fixation.
    Wound closure and care after surgery are the same as
    for IVRO or SSRO.

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