Sub-lingula Osteotomy—A Novel Modification of Sagittal Split Osteotomy

Sagittal split osteotomy is still considered as a difficult procedure though there are many modifications to make it safer, more reliable, and more predictable with less relapse. Currently the most accepted technique of sagittal split osteotomy is the modification described by Epker in 1957. In Epker's modification, the medial ramus osteotomy is the most difficult to perform and may cause bad split at times, especially if the ramus is thin and/ or lingula is placed at a higher level. In this article, the authors describe a novel sublingula technique of medial ramus osteotomy, which makes the osteotomy easier and predictable with less risk of bad split without additional risk of damage to inferior alveolar nerve. Fifteen patients (30 sides) underwent surgery using the sublingula osteotomy technique. CBCT was taken for all patients as a guide to locate lingula, mandibular foramen, and inferior alveolar nerve. This novel modification of sagittal split osteotomy makes the medial ramus osteotomy easier to perform and reliable as the cut is low and short with less risk of bad split without additional risk of damage to inferior alveolar nerve. The use of CBCT to locate anatomical structures helps in precise planning of the osteotomy, and hence, this modification works well with less experienced surgeons.