Incision to the sagittal temporalis tendon to optimise access to the ramus.

Since Trauner and Obwegeser 1 Trauner R. Obwegeser H.L. On the surgical technique of progyny and other mandibular anomalies. Deutsche Gesellschaft für Zahn-, Mund- und Kieferheilkunde. 1955; 23 (paper in German): 1-26 Google Scholar developed the intraoral sagittal ramus split osteotomy in 1953 it has become a mainstay of orthognathic surgery. The techniques have evolved over many years, with Dal Pont 2 Dal Pont G. Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv. 1961; 19: 42-47 PubMed Google Scholar adding the advancement and rotation of the lower horizontal cut to the buccal cortex (with a vertical cut between the first and second molars) and Hunsuck 3 Hunsuck E.E. A modified intraoral sagittal splitting technic for correction of mandibular prognathism. J Oral Surg. 1968; 26: 250-253 PubMed Google Scholar shortening the lingual cut. The approach and access have, however, remained largely the same. All three techniques require access to the ramus and tunneling of the lingual pterygomandibular space. 4 Böckmann R. Meyns J. Dik E. et al. The modifications of the sagittal ramus split osteotomy: a literature review. Plast Reconstr Surg Glob Open. 2015; 2e271 Crossref PubMed Scopus (41) Google Scholar The tunnelling offers the challenge of gaining predictable and consistent access above the lingula, because the mucosa often bunches up and restricts access to less than 1 cm. We have developed a modification to the standard approach that helps to maximise access and minimise the risk of damage to the inferior alveolar nerve, which the principal surgeon has used successfully for 15 years.