Minimally invasive orthognathic surgery: Endoscopic vertical ramus osteotomy

Maria J. Troulis, Oded Nahlieli, Frank Castano, Leonard B. Kaban

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


The endoscopic procedure for placement and activation of a distraction device for mandibular advancement has been previously reported20. The purpose of this study was to demonstrate the feasibility of endoscopic exposure, dissection and osteotomy for mandibular set-back. Two cadaver and three anesthetized minipigs were used in this study. Access to the mandibular ramus was achieved through a 2.0 cm submandibular incision. The dissection was carried sharply to the mandible and completed in the subperiosteal plane. Visualization was achieved using a 2.7 mm diameter endoscope (Karl Storz, Germany). Landmarks were identified and a custom-made retractor was inserted into the sigmoid notch. A vertical ramus osteotomy was created (bilaterally) from the sigmoid notch to the mandibular angle. The mandible was set back (average 6 mm) and fixed using 2.0 mm diameter, bicortical screws. Live animals were sacrificed three weeks postoperatively. The mandibles were examined clinically and radiographically to verify proper osteotomy position and clinical union. In all animals, exposure, accurate identification of landmarks, osteotomy placement and screw fixation were achieved. In the live animals (n=3), union between the proximal and distal segments was documented by clinical and radiographic examination. This study demonstrates the feasibility of the EVRO procedure for mandibular set-back in a minipig model.

Original languageEnglish
Pages (from-to)239-242
Number of pages4
JournalInternational Journal of Oral and Maxillofacial Surgery
Issue number4
StatePublished - 1 Jan 2000
Externally publishedYes


  • Endoscopic
  • Mandible
  • Minimally invasive
  • Ramus osteotomy


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