Mandibular Widening: Hyrax
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Cesar A. Guerrero, DDS, William H. Bell, DDS

Osteotomy & Device Placement

The incision is made 4 to 6 mm labial to the depth of the mandibular vestible through the orbicularis oris muscle. After the muscle is transected, the dissection is directed obliquely, posteriorly, and inferiorly through the mentalis muscle until contact is made with the mandibular symphysis. The periosteum is reflected inferiorly to the lower border of the mandible, where a channel retractor is placed. The soft tissue between the mandibular central incisors is carefully reflected superiorly to the alveolar crest with minimal detachment of the neighboring tissues.

A vertical osteotomy is made through the symphyseal area with a reciprocating or oscillating saw blade starting at the inferior border of the mandible and extending to the interdental space between the apices of the mandibular incisors.

FIG. 6.2.1.1. A vertical osteotomy is made from the inferior border of the mandibular symphysis to the area below the level of the incisors.