Inverted L Mandibular Osteotomy

The inverted L osteotomy is a useful procedure that can be done intraorally or extraorally. The intraoral procedure is more difficult technically and requires the use of transbuccal instrumentation but avoids an extraoral scar. The inverted L osteotomy is used for advancement or setback of the mandible as an alternative to the sagittal split ramus osteotomy. Indications for this procedure include severe asymmetries or when a thin ramus is present. There is decreased risk of injury to the inferior alveolar nerve over the sagittal split osteotomy. Motor nerve injury is possible with an extraoral procedure. Counterclockwise rotations of the mandibular ramus are possible with both the intraoral or extraoral approaches. The large gaps should be bone grafted with either autogenous or alloplastic material. Stability has not been studied to the same extent as that of a sagittal split but is thought to be similar..