This prospective clinical trial aims to evaluate the clinical and radiographic outcomes of the low sagittal medial ramus osteotomy-a technical modification of the conventional sagittal split osteotomy (SSO)-for treating patients with skeletal Class II and Class III malocclusions.
Standard sagittal split osteotomies carry risks of complications, including unfavorable osteotomy propagation (bad splits) toward the condyle, ramus fragmentation, lingual interference of the distal segment, and inferior alveolar nerve (IAN) injury. To minimize these risks, this study utilizes a modified medial cut positioned low (below the lingula in an area with adequate marrow space) and short (terminating anterior to the lingula). This design aims to prevent osteotomy extension into the condylar region and eliminate lingual interference during segment repositioning.
Patients with skeletal Class II or Class III malocclusion requiring mandibular orthognathic surgery.
Age range from 18 to 45 years old.
Systematically healthy patients classified as ASA physical status I or II (American Society of Anesthesiologists)
Patients with a pre-existing history of inferior alveolar nerve (IAN) sensory impairment.
Patients with active or severe degenerative joint disease (DJD).
Patients with a prior history of orthognathic surgical procedures.
Patients presenting with systemic diseases or conditions known to compromise normal bone healing.