Today many surgical procedures involving head and neck areas can be performed under local anesthesia and intravenous sedation. The authors add to this list the sagittal osteotomies of the mandibular rami, thereby avoiding the need for general anesthesia and a hospital stay. The authors designed a protocol to be followed in a multicenter study (Milan and Barcelona) and applied it in 35 clinical cases with Class II malocclusion. The surgical procedure was performed with the Monitored Anesthesia Care technique, a combination of regional anesthesia and intravenous sedation.The results were good in all the clinical cases; skeletal correction of Class II was achieved in all patients and there were no intraoperative or postoperative complications. The major advantage of this technique is the functional control of the temporomandibular joint, which avoids displacements caused by gravity and the muscular relaxation commonly seen under general anesthesia. Furthermore, this protocol allows a reduction in costs, duration of surgery, and patient morbidity and convalescence.When this technique is accepted without hesitation, all Class II patients with only mandibular deficiency deformity may be treated in the most suitable way, thus providing the most satisfactory outcomes for the patient, orthodontist, and surgeon.