Narrow-Bladed “Endo” Sagittal Split Osteotomy Retractor

Abstract

A modification of the Obwegeser sagittal split retractor is presented. It is slender while still protecting the soft tissues and is particularly suitable for endoscopically assisted surgery.

The narrow- and wide-channeled retractors designed by Hugo L. Obwegeser used during his sagittal split osteotomy [1] have stood the test of half a century. These retractors have been designed to expose the surgical field and to protect the facial artery and mandibular branch of the facial nerve [2]. Modifications, apart from manufacturers’ deviations from the original, have rarely been described. The original Obwegeser retractors are distributed by KLS-Martin (Jacksonville, FL) and Medicon (Tuttlingen, Germany).

When coming across the article of Matsushita in the February 2015 issue of this journal [3], in which the author describes a wider spatula-like modification, I considered it interesting to publish on a narrower gutter-shaped modification [4,5]. This one was designed for the endoscopic approach.

However, many colleagues and myself find the instrument useful for “open-sky” sagittal split ramus osteotomies because it has a favorable angle of attack and a sharp tip that allows for easy subperiosteal dissection (both buccally and lingually; Figure 1 and Figure 2). It snugly fits the lower and posterior border (Figure 3), and it protects the soft tissues not by being wider, but by its “guarding” relationship when placed against the bony surface (Figure 3 and Figure 4). Since its design nearly 10 years ago, I have performed approximately 800 bilateral and unilateral sagittal split osteotomies with it and find it highly effective. Test models were made by DePuy Synthes (Solothurn, Switzerland). The instrument is available at Surgi-Tec NV, Sint-Denijs-Westrem, Belgium (www.surgi-tec.com).