Complementary Osteotomies to the Sagittal Split Ramus Osteotomy for Passive Condylar Seating in Asymmetric Mandibular Setbacks With Axial (Yaw) Rotation in Skeletal Class III Patients: A 22-Case Series and Systematic Review.

Authors

Pedro Tapia Contreras, Pedro Solé Ventura, Carlos Becerra Martin, Cristóbal Rueda Lama, Jessica Zeballos Cofré, Micaela Schälchli Montenegro, María J Flores-Mancilla

Published in

The Journal of craniofacial surgery. Nov 13, 2026. Epub Nov 13, 2026.

Abstract

Sagittal split ramus osteotomy, originally described by Obwegeser, has undergone multiple modifications to facilitate the surgical technique, optimize manipulation of the bony segments, and achieve adequate rigid internal fixation during orthognathic surgery. Passive seating of the condyles within the glenoid fossae is essential for successful outcomes. However, 3-dimensional mandibular movements during correction of dentofacial deformities may generate bony interferences between the segments, preventing passive condylar seating and potentially altering temporomandibular joint position and the planned occlusion.
The purpose of this study was to describe complementary osteotomies to the sagittal split ramus technique modified by Dal Pont and Epker in 22 patients with skeletal class III deformity and mandibular asymmetry. Osteotomies were performed in the proximal segment of one hemimandible and the retromolar trigone of the contralateral tooth-bearing distal segment to eliminate bony interferences during asymmetric mandibular setbacks with axial rotation (yaw). Additionally, a systematic review of the literature was conducted.
In all 22 patients, passive seating of the mandibular rami and condyles was achieved, with stable occlusion, adequate mandibular function, and satisfactory clinical and imaging findings during 1 year of follow-up. The systematic review showed that complementary osteotomies facilitate passive condylar seating and bony segment adaptation, particularly in asymmetric mandibular corrections involving greater axial rotation.
Complementary mandibular osteotomies represent a selective technical strategy for eliminating bony interferences during asymmetric mandibular setbacks with axial rotation (yaw). Their use facilitates passive adaptation of the proximal and distal segments before rigid internal fixation, particularly when greater rotational movements prevent passive condylar seating.

PMID:
43021664
Bibliographic data and abstract were imported from PubMed on 13 Nov 2026.

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