Enhancing facial aesthetics: Vertical ramus osteotomies for mandibular disproportions

Orthognathic surgery has evolved significantly. While sagittal split ramus osteotomies with rigid fixation are now the preferred technique, vertical ramus osteotomies remain beneficial in specific cases. This report details three cases where virtual surgical planning achieved excellent outcomes with vertical ramus osteotomies. This case series presents three patients with severe mandibular prognathism and facial asymmetry. All patients were treated using a combined approach of Le Fort I osteotomy and intraoral vertical ramus osteotomies, guided by virtual surgical planning. Long-term occlusal stability and aesthetic improvements were achieved at the 1- and 1.5-year follow-up. The selection of the surgical technique for mandibular osteotomies is a crucial aspect of orthognathic treatment planning. While the sagittal split ramus osteotomy has become the workhorse procedure in many centers, the vertical ramus osteotomy presents a distinct set of benefits that justify its consideration in carefully selected cases. Vertical ramus osteotomy remains a valuable surgical option for patients with severe prognathism and significant mandibular asymmetries. The presented cases demonstrate the potential for excellent clinical outcomes with this technique, suggesting its value in the orthognathic surgeon's armamentarium. • Vertical ramus osteotomy is a surgical option for severe mandibular prognathism and asymmetry. • Vertical ramus osteotomies can significantly relieve temporomandibular joint pain by optimizing disc-condyle relationships. • Vertical ramus osteotomies are a safe and quick procedure with a low complication rate. • Optimal outcomes require individualized patient treatment. • Orthognathic surgery can positively impact patients' self-esteem through improved facial aesthetics.