Precision and Variability: Exploring Osteotomy Cuts in Sagittal Ramus Osteotomy—A Review

ABSTRACT Background Dr. Hugo Obwegeser first performed sagittal ramus osteotomy (SRO), a crucial orthognathic surgery technique, in the 1950s. Anatomical variations, surgeon skill, and procedural adjustments all contribute to the persistence of result variability despite improvements in imaging, instrumentation, and procedures. Objective This review explores the precision and variability of osteotomy cuts in SRO, emphasizing the role of technological advancements, anatomical considerations, and surgical expertise. Methods A comprehensive literature review was conducted, analyzing historical modifications, osteotomy techniques, and emerging technologies such as CAD, CBCT, and intraoperative navigation. Various osteotomy designs were compared for their effectiveness in optimizing surgical outcomes. Results Modifications by Schuchardt, Obwegeser, Dal Pont, Hunsuck, and Epker have improved SRO stability and predictability. Innovations like piezoelectric bone surgery and CAD/CAM guides enhance precision. Studies highlight that anatomical variations influence split patterns, and technologies like VR training and intraoperative navigation help standardize osteotomy cuts. Conclusion Although SRO precision has increased because of technological developments but variability still exists. Better results require a multidisciplinary approach that incorporates cutting edge technologies, surgical expertise, and meticulous preoperative preparation. Future research should refine osteotomy techniques and enhance technological integration for improved predictability.