Adaptation of an osteotome to produce a predictable sagittal split ramus osteotomy

Adaptation of an osteotome to produce a predictable sagittal split ramus osteotomy: When using an osteotome (as opposed to a technique using a spreader) for bilateral sagittal split osteotomy, it is important to separate the buccal cortex from the intramedullary bone (involving the inferior alveolar neurovascular bundle) before the split by twisting the osteotome).1 A thin sharp osteotome is usually malleted into the groove created on the buccal shelf, and the junction is separated in advance. During malleting, particular care should be taken not to damage or transect the neurovascular bundle because it is close to this junction, and the buccal shelf is narrow. (Source: The British Journal of Oral and Maxillofacial Surgery)