Mandibular body osteotomy for skeletal Class III malocclusion: a case-based review

Abstract

Mandibular step body osteotomy has been out of favour since more stable ramus osteotomies were refined and used for jaw deformities. Mandibular body osteotomy still has certain indications for which it is preferable over ramus osteotomies. Mandibular body osteotomy is best suited to correct prognathism caused by mandibular body excess with a retained tooth or in presence of extraction space, with good posterior occlusion, when ramus osteotomies and setback will lead to loss of the last tooth and non-obtuse gonial angle. Other indications are apertognathia, mandibu­lar asymmetry and small advancements of the anterior mandible.

Here we present a case 24 year male with a skeletal class III malocclusion managed with an intra­oral mandibular step osteotomy and setback of 8 mm. One-year followup has shown minimum neurosensory and odontogenic complications associated with mandibular step osteotomy and very high satisfaction among the patient. We also present a brief review of the indications, modifi­cations and refinement of the technique and summarize current published clinical usage.

This is a very stable osteotomy with favourable fracture pattern and does not involve stripping or change in position of muscles of mastication thereby ensures long term stability and minimal risk of relapse. This surgery also has minimal effect on airway narrowing compared to the ramus osteotomy setback. For some specific indications not suited to a sagittal split ramus osteotomy, mandibular body step osteotomy still has relevance and usage.