Deglove
Don’t need to see nerve
Use raytech and broad periosteal
Guide in
Screw
Score cut
Score midline
Score verticals
Remove guide
Put vertical plate in. Do your hole so you know your vertical length of your plate placement
Do your vertical osteotomy first
Then your lateral. Feel the inf border. Get both cortices
Connect
Plate
If screw is tight, then back it out like an implant plate
When you screw don’t push. Just turn
You can displace the segments
Must be sure the osteomies line up
Use a cocher to take the middle segments
⁃go through mucosa about canine to canine. use broad periosteal end
⁃dissect down, you dont need to dissect up
⁃go down to inferior border
⁃use the bovie if the muscle attachment is too strong
⁃identify the nerve laterally
⁃go below with broad end, slide backward under the nerve
⁃should see nerve up and below
if you ever have to skeletonize a nerve, use a 15 blade to open it
⁃use a sagittal saw for genio
⁃mark the midline
⁃finger outside should feel the saw poking out
⁃be sure you go through both cortices
⁃go deep, you almost sink the whole saw but be sure you dont go through skin, meet the midline
⁃genio should break easily
⁃to plate it, use a prestock genio plate
⁃or lag it, maybe like a 16 or 18 mm screw, must have had to angle it up. need the gun drill bit at an angle through a drill guide
⁃screw these big screws fast
