Incision to the sagittal temporalis tendon to optimise access to the ramus

Since Trauner and Obwegeser1 developed the intraoral sagittal ramus split osteotomy in 1953 it has become a mainstay of orthognathic surgery. The techniques have evolved over many years, with Dal Pont2 adding the advancement and rotation of the lower horizontal cut to the buccal cortex (with a vertical cut between the first and second molars) and Hunsuck3 shortening the lingual cut. The approach and access have, however, remained largely the same. All three techniques require access to the ramus and tunneling of the lingual pterygomandibular space.

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