Endoscopic assisted rigid fixation in intra-oral vertical subsigmoid osteotomy: a preliminary study

Abstract

INTRODUCTION: Intra-oral vertical subsigmoid osteotomy (IVSO) is a mandibular ramus osteotomy technique used to correct mandibular prognathism. It is an easily learned surgical procedure executed transorally, and results in fewer neurosensory disturbances than sagittal split osteotomy. However, the intra-oral route limits visibility and makes access to the application of rigid fixation difficult. Post-operative intermaxillary fixation (IMF) for several weeks is mandatory to ensure stability for bone healing. OBJECTIVES: (1) To illustrate the clinical technique of endoscope-assisted rigid fixation in intra-oral vertical sub-sigmoid osteotomy (VSO); and (2) to report on early post-operative morbidities. MATERIAL AND METHODS: Six patients presenting with Class 3 skeletal profile were recruited. The osteotomy was performed through an intra-oral route. Rigid fixation was achieved with a 3mm stab incision located inferior to the ear pinna allowing access to the transbuccal trocar. A rigid endoscope was introduced intra-orally to improve visibility during fixation. Patients’ preoperative and 3-month post-operative radiographs and clinical morbidities (neurosensory status & temporomandibular joint (TMJ) function) were assessed. RESULTS: 83.3% of patients fully recovered inferior alveolar nerve function, and 66.6% recovered TMJ function. The scar from the stab incision was effectively camouflaged by the ear pinna, and was not noticeable by the patients. CONCLUSION: This preliminary study confirms that the application of endoscope-assisted rigid fixation in intra-oral VSO is clinically feasible. All the patients presented with minimal clinical morbidities and good stability at the early post-operative period.