Modification of the Bilateral Sagittal Split Osteotomy for the Asymmetric Mandible

The asymmetric mandible is often corrected using the bilateral sagittal split osteotomy. Significant rotation or lateralization of the dentate (distal) segment to correct an asymmetry often results in misalignment of the proximal and distal segments. Fixation of the 2 segments can displace the proximal segment out of the glenoid fossa, leading to postoperative malocclusion. A technique using a cortical bone shim between the 2 segments to maintain the passive position of the proximal segment is presented.