Total Mandibular Subapical Alveolar Osteotomy to Correct Class II Division I Dentofacial Deformity

Figure 4

Surgical technique. (a) A “V” incision was conducted from the right to left retromolar region, and a mucoperiosteal flap was carefully detached to maintain the mental nerve integrity. (b) A ring of cortical bone was removed around the mental foramen, aiming to create a space around it. A gradual and careful removal of the buccal cortical bone with a drill exposed the inferior alveolar neurovascular bundle and let it free in all of its extension from the foramen to the retromolar region. (c) Once the inferior alveolar neurovascular bundle was viewed in its entirety, it was carefully removed from the inferior dental canal and repositioned either inferiorly or superiorly to it. (d) After nerve repositioning, a reciprocate saw was carefully used to conduct an osteotomy from the mental foramen to the retromolar region, to divide the lingual cortical bone from the basal bone, careful to avoid damage to the posterior teeth’s apices. (e) After the dentoalveolar segment containing the entire lower dentition was mobilized, it was repositioned to the desired site and stabilized with miniplates and screws of the system 2.0.

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