Introduction: Inverted “L” osteotomy mainly used for syndromic patients with short ramus, orthognathic surgery complications and important mandibular advancement with counterclockwise rotation.

Patients and methods: We present our experiencie of 20 years. Twenty-six patients were treated with this osteotomy (8 orthognathic surgery complications, 3 Treacher-Collins syndrome, 2 hemifacial microsomia, 3 rheumatoid artritis, 10 class II malocclusion nonsyndromic). Evaluate surgical tecnique, stability (radiology and occlusal registration) and complications. The technique described: retromandibular incision, expose the ramus, and invertid L-sahped section is performed 1 cm from antilingula and 2 cm below sigmoid nocth, estimate the vertical and longitudinal defect in occlusion, we use in 21 patients left parietal graft and in 5 iliac crest graft. The osteotomies were fixed rigidly with miniplates in 24 cases and in 2 cases with reconstruction plate. Maxillary surgery was performed in 25 cases and in all genioplasty.

Results: Twenty-five patientes maintained stability, one patient had massive bleeding infratemporal fossa.

Conclusions: Inverted “L” osteotomy is stable, predectible and safe in patients who require a significant increase in mandibular advancement and increase vertical ramus. The use of miniplates and membranous bone allow for greater stability than sagittal splits osteotomy and distraction osteogenesis.