The proximal segment in sagittal split ramus osteotomy

Bilateral sagittal split ramus osteotomy is one of the most versatile techniques in orthognathic surgery that allows for the repositioning of the mandible in all directions. This osteotomy splits the mandible into two proximal condyle-bearing segments and one distal tooth-bearing segment.Intraoperatively, the surgeon is usually focused primarily on the proper positioning of the distal segment to achieve the planned amount of advancement or setback. However, particular attention should be paid to the position of the proximal segment, as improper positioning of the proximal segment during fixation gives rise to immediate or late relapse of the surgical outcomes. The goal of this paper is to provide some background knowledge about the proximal segment for the novice surgeons, based on a review of the relevant literature. What is the proper position of the proximal segment, and what is the best technique to guide the proximal segment into its proper position?. These questions do not have clear-cut answers that the majority of surgeons agree on.