Accordingly, a linear and vertical osteotomy of the tibia was done distally inch by inch during attempted extraction without damaging the three Tibial columns.
We recommend that to extract an impacted double nail, an early decision should be made to do a vertical osteotomy without disturbing the three columns of the tibia to free the implant which heals with minimal morbidity.
So it was decided to increase ramus height by vertical osteotomy
of right ramus, coronoidectomy of the same side to improve mouth opening and a therapeutic augmentation of the mandible via distraction osteogenesis was planned.
During this time, bony union occurs across osteotomy margins (the vertical osteotomy
cut lines and in the distraction zone), and the gingiva expands to the new alveolar bone volume3, 7.