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* contraindications: Thin ramus (<10mm) Superior position of mandibular canal Third molar pathology Previous sagittal split osteotomy * The incision begins in the buccal vestibule medial to the external oblique ridge and extends anteriorly and lateral to the retromolar pad. * Starting the incision on the ascending ramus no higher than the level of the occlusal plane minimizes the possibility of cutting the buccal artery or exposing the buccal fat pad. * If the posterior mandible is the recipient site for the graft, the incision should bisect the keratinized mucosa on the residual ridge crest. * The external oblique osteotomy is started anterior to the coronoid process at a point where adequate thickness develops (7-8mm). * This osteotomy is made approximately 3-5mm medial to the external oblique ridge. * The external oblique osteotomy may be extended anteriorly into the body of the mandible as far as the distal aspect of the first molar area. * The length of thre graft may approach 40mm, but the height usuallyis not much greater than 10-15mm. *Although the buccolingual position of the mandibular canal is variable, the distance from the canal to the inner aspect of the buccal cortex (medullary bone thickness) was found to be greatest at the distal half of the first molar. 
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