Intraoral vertical ramus osteotomy (IVRO) is a useful technique in the management of horizontal mandibular excess, mandibular asymmetry, and correction of minor mandibular defi- ciency. Originally performed through an extraoral approach, with the introduction of the power oscillating saw, the procedure has been performed transorally for more than 30 years. The goal of the procedure is to perform a full-thickness vertical osteotomy through the mandibular ramus posterior to the mandibular foramen with the creation of a proximal segment consisting of the condyle and posterior ramus and a distal segment containing the anterior ramus, coronoid process, inferior alveolar nerve, and tooth-bearing mandible. It is a technically straightforward procedure that can be performed efficiently and with low morbidity. This article reviews the technical considerations, technical modifications, and potential pitfalls in performing IVRO.