Two groups with mandibular prognanthism indicated for mandibular setback by intraoral vertical ramus osteotomy . first group will fixed with maxillomandibular fixation and the second group will fixed by customized plate~Interventions:~General operative procedures~Eligible patients will be randomized in equal proportions between the study group (customized plate fixation of VRO) and the control group (maxillomandibular fixation of VRO).~Patients of Both groups will be subjected to:~Case history including personal data, medical, surgical history and family history~Clinical examination .~Radiographic examination in the form of cephalometric radiogragh .~Preoperative laboratory tests (complete blood cell count, Hemoglobin count, coagulation profile, liver function, kidney function and blood glucose level).~Preoperative anesthesia assessment for fitness for general anesthesia.~vertical ramus osteotmy fixed with customized plate~All cases will undergo one surgery under general anesthesia.~Incision was made medial to external oblique ridge from the asendindg ramus to second molar region~Amucoperiosteal flap was reflected to expose the lateral mandibular ramus to the posterior border and the sigmoid notch~The intraoral vertical osteotomy is accomplished by using an oscillating saw to make the cut from the sigmoid notch through the inferior border of the mandible. The osteotomy is placed 5 mm anterior to the posterior border of the mandible to avoid injury to the inferior alveolar neurovascular bundle~3D virtual planning and 3D mandible model represented fom CBCT in MIMICS~The setback will be simulated according to pre-planned measure~The customized bone plate is positioned to fix the proximal and distal segment together~vertical ramus osteotomy fixed with MMF.~All cases will undergo one surgery under general anesthesia.~incision was made medial to external oblique ridge from the asendindg ramus to second molar region .~Amucoperiosteal flap was reflected to expose the lateral mandibular ramus to the posterior border and the sigmoid notch~The intraoral vertical osteotomy is accomplished by using an oscillating saw to make the cut from the sigmoid notch through the inferior border of the mandible. The osteotomy is placed 5 mm anterior to the posterior border of the mandible to avoid injury to inferior alveolar neurovascular bundle.~Patient is placed in maxillomandibular fixation (MMF) using a prefabricated occlusal splint to assure accuracy of the mandibular position.~follow up clinical and radiographic evaluation will be performed at the first week postoperative then the patients will recalled for radiograghic evaluation at 2weeks and 2 months .finall follow up visit will be at 6 months postoperative
Two groups with mandibular prognanthism indicated for mandibular setback by intraoral vertical ramus osteotomy . first group will fixed with maxillomandibular fixation and the second group will fixed by customized plate