Orthognathic surgery is highly effective in improving overall facial esthetics, in addition to achieving an ideal occlusion. Sagittal split ramus osteotomy (SSRO) of the mandible is the mainstay of modern orthognathic surgery, but intraoperative injury to the inferior alveolar nerve (IAN) remains one of the common complications. The authors report a case of 19-year-old male patient with left cleft lip and palate who received orthognathic surgery involving SSRO. The patient's right IAN ran close to the outer cortex of the mandible, but SSRO was successfully performed without injuring the nerve. Detailed preoperative evaluation using computed tomography images is essential. Blind splitting maneuvers during SSRO may cause IAN injury, and direct visualization inside the ramus helps to prevent injury to the nerve. Sagittal split ramus osteotomy could be considered as a viable option even when the IAN runs close to the outer cortex. This article describes SSRO procedures, highlighting the methods to avoid nerve injury.
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