Open Access
J Oral Med Oral Surg
Volume 29, Number 2, 2023
Article Number 17
Number of page(s) 1
Published online 31 May 2023

Dear Editor,

We read with great interest the article from Bastidas Castillo and Ramirez Naranjo entitled “A modified sagittal split osteotomy: description of technique” [1]. The authors report a new technique of mandibular osteotomy allowing the lengthening of the mandibular ramus while ensuring a large bone contact surface between the two segments. We congratulate the authors particularly for the clarity of their iconographies. We are nevertheless surprised that your article does not refer to the article by Grimaud et al. entitled “Vertical ramus elongation and mandibular advancement by endobuccal approach: Presentation of a new osteotomy technique” published in 2017 and currently used in our department [2].

The treatment of PVI can be challenging both for orthodontists and for maxillofacial surgeons. Surgical treatment aims to achieve facial symmetry and normal occlusion, as well as functional and aesthetic outcomes after completion of growth. Various techniques have been described to achieve this goal. If the costo-chondral graft remains the gold standard for the replacement of the temporo-mandibular joint (TMJ), more conventional orthognathic procedures are applied in case of functional TMJ [3]. The vertical ramus osteotomy according to the Caldwell-Letterman technique offers good long-term aesthetic and architectural results [4]. Others orthognathic procedures have been described including the L-inverted osteotomy or the Epker-modified-Wolford osteotomy after complete sectioning of the pterygomasseteric sling [5,6]. Irrespective of the technique used, it must be evaluated with long-term results as long-term relapse is frequently described, thus requiring further procedures.

Another point that needs to be clarified is the osteosynthesis technique used. The endobuccal approach should be preferred as it does not cause facial scarring, but it requires the use of angled material for drilling and screwing. The transjugal approach is an alternative, especially for access to the most inferior and posterior screws.


  1. Bastidas Castillo D.A., Ramirez Naranjo P.A. modified sagittal split osteotomy: description of technique. J Oral Med Oral Surg 2022;28:49. [Google Scholar]
  2. Grimaud F, Bertin H, Fauvel F, Corre P, Perrin J-P. Vertical ramus elongation and mandibular advancement by endobuccal approach: Presentation of a new osteotomy technique. J Stomatol Oral Maxillofac Surg 2017;118:66–69. [CrossRef] [PubMed] [Google Scholar]
  3. Bertin H, Mercier J, Cohen A, Giordanetto J, Cohen N, Lee SH, et al. Surgical correction of mandibular hypoplasia in hemifacial microsomia: A retrospective study in 39 patients. J Craniomaxillofac Surg 2017;45:1031-1038. [PubMed] [Google Scholar]
  4. Anquetil M, Mercier J, Leveau S, Mrabet S, Durand T, Salagnac J-M, et al. Evaluation of vertical ramus osteotomy for the surgical correction of unilateral mandibular posterior vertical insufficiency: Long-term follow-up results. J Craniomaxillofac Surg 2020;48: 349-356. [PubMed] [Google Scholar]
  5. Medeiros PJ, Ritto F. Indications for the inverted-L osteotomy: report of 3 cases. J Oral Maxillofac Surg 2009;67:435–444. [CrossRef] [PubMed] [Google Scholar]
  6. Ferri J, Girod A, Serghini A, Lemière E. Lengthening the mandibular ramus without external access. Rev Stomatol Chir Maxillofac 2006;107:38–40. [CrossRef] [PubMed] [Google Scholar]

© The authors, 2023

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