Bedside Reduction of a Malpositioned Proximal Segment Following Intraoral Vertical Ramus Osteotomy (IVRO): A Technique Report

This technique report describes a novel bedside method for the reduction of a malpositioned proximal segment following intraoral vertical ramus osteotomy (IVRO). A 74-year-old male with a history of acromegaly presented with mandibular prognathism and skeletal Class III malocclusion. The patient underwent bimaxillary orthognathic surgery consisting of IVRO for mandibular setback and a Le Fort I osteotomy for maxillary advancement. The patient elected IVRO to minimize the risk of inferior alveolar nerve (IAN) injury. Postoperatively, the patient experienced respiratory decompensation resulting in excessive mandibular manipulation. Subsequent imaging revealed medial displacement of the left proximal segment, an unfavorable position that could compromise occlusal stability, condylar seating, and IAN entrapment. Instead of returning the patient to the operating room, a novel bedside reduction maneuver was performed using manual digital manipulation. The proximal segment was successfully repositioned into the correct lateral orientation relative to the distal segment confirmed by post-procedural imaging. • Novel bedside reduction of a malpositioned IVRO proximal segment • Technique avoided return to the operating room and repeat anesthesia • Additional commentary added to section 2.2 discussing appropriate proximal segment positioning prior to airway incident • Post operative day 2 CT reconstruction included demonstrating properly reduced segments