The influence of orthognathic surgery on ventilation during sleep

Orthognathic surgery has varying effects on respiratory parameters. The authors undertook a prospective study of patients requiring mandibular advancement, mandibular setback and maxillary Le Fort I advancement, and surgically assisted rapid maxillary expansion (SARME). Breathing parameters were monitored in a sleep laboratory the night before the operation and in a mean of 9.5 months after the operation. In patients treated with mandibular advancement, the respiratory disturbance index (RDI), oxygen desaturation index (ODI), and number of obstructive apnoeas (OAs) improved significantly. In patients treated with mandibular setback and maxillary Le Fort I advancement, the RDI, ODI, index of flow limitations (IFL), number of obstructive hypopnoeas (OHs), OA, and oxygen saturation deteriorated. In contrast, patients treated with SARME improved only mildly. These results indicate that bimaxillary surgery for Class III malocclusion increased upper airway resistance, probably because of a more dorsal positioning of the base of the tongue, representing an iatrogenic obstructive sleep apnoea (OSA). A young person would probably be able to balance such a decline in respiratory function using different adaptative mechanisms. Mandibular advancement significantly improved respiratory parameters during sleep. The possible effect of orthognathic surgery on the upper airways should be incorporated into the treatment plan.     

Le FortⅠ型骨切开上颌骨整体后退术矫治骨性Ⅱ类上颌骨前突畸形

目的：探讨Le Fort Ⅰ型骨切开（Le Fort Ⅰ osteotomy）上颌骨整体后退术在矫治骨性Ⅱ类上颌骨前突畸形中的价值。方法：对16例骨性Ⅱ类上颌前突患者（上颌骨前突伴下颌骨后缩14例,其中同时伴颏后缩6例;单纯上颌骨前突2例）进行外科-正畸联合治疗。患者治疗前头影测量∠ANB为7.0°～13.1°,平均9.3°。行Le Fort Ⅰ型骨切开上颌骨整体后退术,其中14例同期行双侧下颌支矢状骨劈开术（bilateral sagittal split ramus osteotomy,BSSRO）前移下颌骨,6例行颏成形术（genioplasty）前移颏部。结果：本组行LeFortⅠ型骨切开上颌骨整体后退4～8mm,14例BSSRO下颌骨前移4～7mm,6例颏成形术颏前移6～8mm。1例一侧腭降动脉术中损伤断裂,经结扎处理,无感染及骨块坏死。16例患者伤口均一期愈合。术后及正畸结束后∠ANB为1.6°～3.5°,平均2.9°。结束治疗后随访6～24个月,牙弓形态及[牙合]曲线正常,牙排列整齐,咬合关系良好,外形明显改善,疗效满意。结论：对于骨性Ⅱ类上颌骨前突畸形患者,Le Fort Ⅰ型骨切开上颌骨整体后退术是一种安全、合理、有效的正颌外科术式。     

The stability of bilateral sagittal ramus osteotomy and vertical ramus osteotomy after bimaxillary correction of class III malocclusion

Introduction

The purpose of this retrospective cephalometric study was to compare the stability of bilateral sagittal split osteotomy (BSSO) with extra-oral vertical ramus osteotomy (VRO) after correction of class III malocclusion by means of bimaxillary orthognathic surgery.

Methods

The sample comprised 51 consecutively treated patients, 38 females and 13 males, with a mean age of 19.1 years. All had a one-piece Le Fort I osteotomy with maxillary advancement and mandibular setback. VRO was performed in 30 cases, and BSSO was performed in 21 cases. Lateral cephalograms were obtained before surgery, within 1 week of surgery and 1 year after surgery.

Results

The mean forward movement of the maxilla was 5.6 mm in both groups (p < 0.001). The mean horizontal surgical change in the VRO group was 4.4 mm (p < 0.001), and in the BSSO group it was 5.4 mm (p < 0.001). In the VRO group, the horizontal relapse was 1.2 mm (p < 0.001), and in the BSSO group, it was 1.4 mm (p < 0.001).

Conclusion

There was no difference in the stability between the BSSO and VRO groups. The average relapse in the whole sample was 26% of the surgical movement.     

Changes in condylar position after orthognathic surgery and its correlation with temporomandibular symptoms (TMD)- a prospective study

The aim of the study was to assess the changes in the condylar position after orthognathic surgery (OGS) and its effect on temporomandibular disorders (TMD). A total of 37 dentofacial deformity patients included in the study who had undergone OGS were divided into three groups: Group I, Le Fort I maxillary advancement; Group II, bilateral sagittal split osteotomy (BSSO) mandibular advancement ± Le Fort I; and Group III, BSSO mandibular setback ± Le Fort I. Patients were evaluated clinically using Diagnostic Criteria for TMD and by radiography preoperatively and 6 months postoperatively. The positional changes in condyle were correlated with signs and symptoms of TMD. A total of 37 patients in three groups (Group I, 8 patients; Group II, 10 patients; and Group III, 19 patients) were evaluated. Overall, condyles had anterio-medio-inferior movement with 7 of 8 patients in Group I, 6 of 10 patients in Group II and 13 of 19 patients in Group III having ≤2 mm displacement. In angular changes, inward-anterio-medial movement was observed with 6 of 8 patients in Group I; about 5 of 10 patients, and 10 of 19 patients in Group II and III respectively had ≤5° change. Intragroup and intergroup comparisons showed insignificant changes in TMD and linear/angular movement (p ≥ 0.05). Pearson correlation coefficient was found to be nonsignificant on the radiographic and clinical comparison (p ≥ 0.05). Intrarater reliability (Kappa value) was found to be 0.83, confirming the results. Within the limitations of the study it seems that there are minimal linear and angular changes in condyle after orthognathic surgery that were not responsible for the development of temporomandibular disorders in the postoperative course.     

Soft tissue changes after mandibular setback and bimaxillary surgery in Class III patients

Objective:To evaluate the relationship between soft tissue and bone structure for Class III patients before and after bilateral sagittal split osteotomy (BSSO) and bimaxillary orthognathic surgery; to determine the impact of other factors on soft tissue change; and to evaluate correlations between thickness of tissue before surgery, SNA, SNB, and ANB angles, and soft tissue changes.Materials and Methods:The study included 78 Class III patients treated only with BSSO or with BSSO and Le Fort I osteotomy. Lateral cephalograms were taken before and 3 months to 1 year after surgery. After all points of the Zagreb82 and Legan and Burstone profile analysis were traced, the ratio of five soft tissue points before and after surgery was evaluated.Results:Soft tissue between points Sn and A and upper lip showed statistically significant changes for patients treated with bimaxillary surgery and BSSO. Only gender had an influence on soft tissue change. The correlation between soft tissue thickness and changes after surgery was significant. A change in SNB angle correlated with upper lip thickness for patients treated with BSSO but not for patients treated with BSSO and Le Fort I. SNA angle changes correlated with soft tissue changes between points Sn and A.Conclusion:Results of this study show soft tissue changes after BSSO and BSSO and Le Fort I and eliminate the deficiencies that were indicated in the meta-analysis of soft tissue changes from a previous study.     

Computerized Cephalometric Study of the Pharyngeal Airway Space in Patients Submitted to Orthognathic Surgery

Introduction

Pharynx is a muscular organ with is sustained by craniofacial bones. It is divided into nasal, oral and hipopharynx, and can be considered as a tube that serves both respiratory and digestive systems. Its anatomical morphology permits that factors facilitate its obstruction, leading to the sleep apnea syndrome. One of the treatment consists of surgical mandibular advancement, increasing pharyngeal dimensions. The aim of this study was evaluate the cephalometric changes in the pharyngeal airway space after orthognathic surgery procedures for correction of mandibular prognathism.

Materials and Methods

Pre and post-operative cephalometric analysis was performed on 19 patients submitted to mandibular setback by mandibular bilateral sagittal split osteotomy associated with maxillary advancement by Le Fort I osteotomy, using the Dolphin Imaging 10.0 software.

Results

Results did not reveal statistically significant changes in the upper (nasopharyngeal), middle (oropharyngeal) and lower (hypopharyngeal) airway spaces, but showed increase in the nasal pharynx due the maxillary advancement and a lower position of the hyoid bone due the mandibular setback.

Discussion

Maxillomandibular orthognathic surgery for correction of mandibular prognathism does not seem to statistically significantly change the pharyngeal airway space, but it increases the maxillary airway.

Conclusion

It seems to be important to consider the double jaw surgery in cases of mandibular prognathism, aiming prevention of a possible reduction of whole upper airway.     

2种不同正颌术式对骨性Ⅲ类错畸形患者上气道形态的影响

目的： 建立骨性Ⅲ类错畸形患者正颌手术前、后上气道三维模型，比较不同正颌术式对骨性Ⅲ类错畸形患者上气道各截面积及容积的影响。方法： 28例骨性Ⅲ类错畸形患者经正颌-正畸联合会诊，制定手术方案，分为2组，实验A组（12例）为单纯双侧下颌支矢状劈开术（BSSRO）后退，即单颌手术组，实验B组（16例）为下颌骨BSSRO 后退 +上颌骨Le Fort I型截骨术前移，即双颌手术组。所有患者于正颌手术前（T1）和术后3个月（T2）分别行CT扫描，基于CT图像，应用Dolphin Imaging 11.7软件建立包含腭咽、舌咽和喉咽腔在内的上气道三维模型，测量、比较2组患者在正颌手术前、后的上气道各截面、腔隙的矢状径、冠状径、横截面积和容积改变的差异。采用SPSS 16.0 软件包进行统计学分析。结果： 在腭咽段，实验A组手术后各项数值均较术前减小；实验B组手术后除冠状径外，其余数值均较术前增大，且2组变化有显著差异（P<0.05）。在舌咽段及喉咽段，2组手术后数值均减小。在横截面积和容积方面，实验A组较实验B组减小更加明显，2组的减小量有显著差异（P<0.05）。结论： 与单颌手术相比，双颌手术对骨性Ⅲ类错畸形患者上气道形态的减小改变影响较小。     

Morphologic outcome of bimaxillary surgery–An anthropometric appraisal

Objectives: To adequately perform orthognathic surgery procedures, it is from basic interest to understand the morphologic changes caused by orthognathic surgery. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate and understand such changes. Study Design: We present a pre- to postoperative evaluation of orthognathic surgery results based on anthropometric indices described by Farkas and cephalometric measurements. 30 Class III patients undergoing maxillary advancement by Le Fort I Osteotomy and mandibular setback by bilateral sagittal split osteotomy were evaluated. Preoperative as well as three and nine months postoperative lateral cephalograms as well as standardized frontal view and profile photographs were taken. On the photographs 21 anthropometric indices given by Farkas were evaluated. In cephalograms SNA and SNB angle as well as Wits appraisal were investigated. Results: The investigated anthropometric indices showed a significant increase of the vertical height of the upper lip without changing the relation of the upper vermilion to the cutaneous upper lip. The lower vermilion height increased relatively to the cutaneous lower lip without vertical changes in the lower lip. Due to maxillary advancement the upper face height increased meanwhile the lower face height decreased due to mandibular setback. SNA and SNB angle and Wits appraisal showed typical changes related to surgery. Conclusions: The investigated photo-assisted anthropometric measurements presented reproducible results related to bimaxillary surgery. Key words:Orthognathic surgery, bimaxillary surgery, anthropometry, Class III.     

Two-stage orthognathic treatment of severe class III malocclusion: report of a case

We report a two-stage orthognathic operation for a 16-year-old boy with a repaired isolated cleft palate. He had a severe class III malocclusion with an overjet of 20.4 mm. In the first stage, we did an anterior subapical segmental osteotomy with symphyseal ostectomy to reposition the mandibular anterior segment posteriorly and to reduce the transverse width of the mandible. During the second stage, we did a maxillary advancement by Le Fort I osteotomy, mandibular set-back by sagittal split osteotomy, reduction genioplasty, and shortening of the tongue. This unique two-stage surgical and orthodontic treatment considerably improved his overall facial aesthetics and occlusion.     

Evaluation of condylar resorption rates after orthognathic surgery in class II and III dentofacial deformities: A systematic review

The purpose of this study was to perform a systematic review of morphological alterations in the condyles after orthographic surgery involving a sagittal split ramus osteotomy (SSRO), with or without surgery on the maxilla. Searches were performed on three databases and registered in the PROSPERO. The selected studies fulfilled the criteria established by the following PICO model: (1) population: individuals with skeletal dentofacial deformities (class II or III facial patterns), without asymmetry; (2) intervention: orthognathic surgery for mandibular setback using an SSRO, with or without a Le Fort I osteotomy, and fixed with bicortical screws or plates and screws; (3) comparison: orthognathic surgery for mandibular advancement using an SSRO, with or without a Le Fort I osteotomy, and fixed with plates and screws or bicortical screws; and (4) outcome: condylar resorption rate and relapse. Initially, 1,371 articles were identified and 636 articles were screened after elimination of duplicates, and 6 articles were selected for qualitative analysis based on the inclusion and exclusion criteria. Five studies had data regarding the rate of condylar resorption, varying from 0.0% to 4.2%. In conclusion, condylar resorption and relapses were present in a small percentage of patients studied.     

Additional orthognathic surgery following Le Fort III and monobloc advancement

Severe midface hypoplasia in patients with various craniofacial anomalies can be corrected with Le Fort III or monobloc advancement. Often additional corrective orthognathic surgery is indicated to achieve Class I occlusion and a normal inter-jaw relationship. This study evaluated the incidence of, and the surgical indications for, secondary orthognathic surgery following Le Fort III/monobloc advancement. The total study group consisted of 41 patients: 36 patients with Le Fort III advancement and 5 patients with monobloc advancement. Seven patients underwent additional orthognathic surgery. Of the resulting 18 non-operated patients older than 18 years at the end of follow-up, Class I occlusion was observed in 11 patients. In the remaining patients malocclusions were dentally compensated with orthodontic treatment. None of the patients was scheduled for additional orthognathic surgery due to the absence of functional complaints and/or resistance to additional surgery. Le Fort III and monobloc advancement aim to correct skeletal deformities on the level of zygoma, orbits, nasal area and forehead, but Class I occlusion is frequently not achieved. Additional orthognathic surgery is often indicated in patients undergoing Le Fort III or monobloc advancement. Naso-endoscopic analysis of the upper airway and the outcomes of sleep studies may influence the orthognathic treatment plan.     

Effect of setback Le Fort I osteotomy on midfacial soft-tissue changes as evaluated by cone-beam computed tomography superimposition for cases of skeletal Class III malocclusion

This study employed the cone-beam computed tomography (CBCT) superimposition method to evaluate postoperative midfacial soft-tissue changes in cases of skeletal Class III malocclusion after double-jaw surgery with setback and vertical reduction Le Fort I osteotomy. A retrospective study was carried out on 15 patients who had undergone maxillary setback Le Fort I osteotomy and mandibular setback sagittal split ramus osteotomy with alar cinch suturing and V-Y soft-tissue closure. Three dimensional CBCT volume scans were recorded preoperatively (T0) and 6 months postoperatively (T1) to measure soft-tissue changes of the upper lip and midface. Post-surgery, soft-tissue landmarks in the cheek and paranasal areas had moved forward; the soft-tissue thickness at the A-point had markedly increased (P < 0.05); there was no significant change in the subnasale, and the midline of the soft-tissue of the upper-lip area had moved backward. The extent of the mean soft-tissue change at the labrale superius was greater than that at the other soft-tissue landmarks of the upper lip. The results suggest that maxillary setback movement of the maxilla by alar cinch suturing has a beneficial effect on paranasal soft-tissue and lip contours for patients with protrusive lip and acute nasolabial angle.     

Stability of skeletal class III malocclusion after combined maxillary and mandibular procedures: rigid internal fixation versus wire osteosynthesis of the mandible.

PURPOSE: The aim of this study was to evaluate skeletal stability after double-jaw surgery for correction of skeletal Class III malocclusion to assess whether there were any differences between wire and rigid fixation of the mandible. PATIENTS AND METHODS: Thirty-seven Class III patients had Le Fort I osteotomy stabilized with plate and screws for maxillary advancement. Bilateral sagittal split osteotomy for mandibular setback was stabilized with wire osteosynthesis and maxillomandibular fixation for 6 weeks in 20 patients (group 1) and with rigid internal fixation in 17 patients (group 2). Lateral cephalograms were taken before surgery, immediately after surgery, 8 weeks after surgery, and 1 year after surgery. RESULTS: Before surgery, both groups were balanced with respect to linear and angular measurements of craniofacial morphology. One year after surgery, maxillary sagittal stability was excellent in both groups, and bilateral sagittal split osteotomy accounted for most of the total horizontal relapse observed. In group 1, significant correlations were found between maxillary advancement and relapse at the posterior maxilla and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. In group 2, significant correlations were found between mandibular setback and intraoperative clockwise rotation of the ramus and between mandibular setback and postoperative counterclockwise rotation of the ramus and mandibular relapse. No significant differences in postoperative skeletal and dental stability between groups were observed except for maxillary posterior vertical position. CONCLUSIONS: Surgical correction of Class III malocclusion after combined maxillary and mandibular procedures appears to be a fairly stable procedure independent of the type of fixation used to stabilize the mandible.     

Morphological changes in the pharyngeal airway of female skeletal class III patients following bimaxillary surgery: A cone beam computed tomography evaluation

Using cone beam computed tomography (CBCT), the present study compared three-dimensional (3D) changes in the pharyngeal airway and surrounding tissues in female skeletal class III patients treated with bimaxillary surgery. Twenty-nine female skeletal class III patients with both maxillary hypoplasia and a mandibular excess underwent bilateral sagittal split ramus osteotomy for mandibular setback combined with Le Fort I osteotomy for maxillary advancement. Volumetric measurements were performed using CBCT scans taken at 1 week presurgery and 6 months post-surgery. The oropharynx volumes and the cross-sectional area behind the soft palate decreased significantly. There was an insignificant change in the volume of the nasopharynx (P > 0.05). The hyoid bone moved downward and posteriorly after surgery. The morphology of the soft palate also changed dramatically, with an increase in the length and thickness. Negative correlations were found between the pharyngeal airway space and the position of the hyoid bone. The change in morphology of the soft palate was significantly correlated with the changes in hyoid bone position. These 3D results suggest that bimaxillary orthognathic surgery significantly changes the position of the hyoid bone and the soft palate together with a significant decrease in the pharyngeal airway space in the correction of skeletal class III malocclusion.     

Stability of skeletal Class III malocclusion after combined maxillary and mandibular procedures

The aim of this study was to evaluate the skeletal stability and time course of postoperative changes after surgical correction of skeletal Class III malocclusion. Combined maxillary and mandibular procedures were performed in 40 consecutive patients. Bilateral sagittal split osteotomy stabilized with wire osteosynthesis for mandibular setback and low-level Le Fort I osteotomy stabilized with plates and screws for maxillary advancement were performed. Maxillomandibular fixation (MMF) was in place for 6 weeks. Lateral cephalograms were taken before surgery, immediately postoperatively, 8 weeks after surgery, and 1 year postoperatively. Patients were divided into 2 groups according to vertical maxillary movement at surgery: a maxilla-up group with upward movement of the posterior nasal spine of 2 mm or more (group 1, n = 22), and a minimal vertical change group with less than 2 mm of vertical repositioning (group 2, n = 18). The results indicate that surgical correction of Class III malocclusion with combined maxillary and mandibular osteotomies appears to be fairly stable. One year postsurgery, maxillary stability was excellent, with a mean horizontal relapse at point A that represented 10.7% of maxillary advancement in group 1 and 13.4% in group 2. In the vertical plane, maxillary stability was also excellent, with a mean of 0.18 mm of superior repositioning at point A for group 1 and 1.19 mm for group 2. The mandible relapsed a mean of 2.97 mm horizontally at pogonion in group 1 (62% of mandibular setback) and 3.41 mm (49.7% of setback) in group 2. Bilateral sagittal split osteotomy with wire osteosynthesis and MMF was not as stable as maxillary advancement and accounted for most of the total horizontal relapse (almost 85%) observed. A trend to relapse was observed for maxillary advancement greater than 6 mm, while the single variable accounting for mandibular relapse in group 1 was the amount of surgical setback. Clockwise rotation of the ascending ramus at surgery was not correlated with mandibular relapse in relation to the type of fixation performed and therefore does not seem to be responsible for relapse.     

面中部牵引成骨结合正颌手术治疗Binder综合征

目的：Binder综合征患者有严重的面部凹陷畸形及咬合功能障碍,治疗相对困难且易复发。本研究探讨面中部牵引结合正颌手术在Binder综合征治疗中的价值。方法：4例Binder综合征患者采用改良Le Fort II型截骨术,术后利用颅骨外置式牵引器进行旋转牵引,并随时调整矢状向及垂直向的量,矫正患者面形。半年后进行正颌手术,矫正咬合关系,并随访1~2 a。结果：4例患者均顺利完成整个治疗过程,无明显并发症发生。牵引过程中无明显疼痛及不适。头影测量显示,患者面中部骨骼显著前移,凹陷畸形得以矫治。经过正颌-正畸联合治疗,获得了良好的咬合关系。结论：上颌骨Le Fort II型截骨牵引可以矫治鼻上颌骨发育不足,通过正颌手术可以矫正咬合关系,两者结合是一种较为理想的治疗Binder综合征的方法。     

How accurate is model planning for orthognathic surgery?

The purpose of this study was to evaluate the accuracy of model surgery prediction after orthognathic surgery and to identify possible errors associated with the prediction process. The study included 46 patients who had undergone orthognathic surgical procedures; 22 in Group A who had had a Le Fort I osteotomy; and 24 in Group B who had had a Le Fort I osteotomy and mandibular setback surgery. The immediate postoperative and preoperative lateral cephalograms were analysed to calculate surgical changes; these were compared with those obtained from model surgery prediction and a statistical analysis was undertaken. The maxilla was more under-advanced and over-impacted anteriorly than predicted by model surgery. The amount of mandibular setback was more than that predicted by model surgery. None of the differences between prediction planning and actual surgical changes was statistically significant at p<0.05. Inaccuracy with the face bow recording, the intermediate wafer, and auto-rotation of the mandible in the supine or anaesthetized patient would appear to be the principal reasons for errors. Inaccuracies are associated with the transfer of prediction planning to model surgery planning and prediction, which should be eliminated to improve the accuracy and predictability of orthognathic surgery.     

常见正颌手术后咬合关系的维护和调整

目的 探讨临床常见的正颌手术后,如何很好的维护和调整上下牙列的咬合关系,为临床提供有益的参考.方法 选择骨性Ⅰ类双颌前突行根尖下截骨后徙术、Ⅱ类下颌后缩行下颌升支矢状劈开前徙术、Ⅲ类骨性反骀行下颌升支骨切开后退及合并上颌前徙术各6例患者,共18例患者.正颌手术后依据分类分别行3种不同的牵引模式进行咬合调整.结果 18例...     

Long-term skeletal stability after surgical correction in Class III open-bite patients: a retrospective study on 40 patients treated with mono- or bimaxillary surgery

Many reports have paid attention to skeletal stability after orthognathic surgery, but only few focalize attention on patients with III class III malocclusion and open bite. In this article, long-term stability (2 yr) of the maxilla and the mandible after orthognathic surgery in 40 patients with class III malocclusion and anterior open bite is evaluated. The sample has been obtained from those 420 patients with class III malocclusion treated with Le Fort I osteotomy isolated (group A, 20 patients) or in association with bilateral sagittal split osteotomy (group B, 20 patients) from 1985 to 2003. On the basis of cephalometric analysis obtained in the immediate postoperative period and 2 years after surgery, in class III patients with anterior open bite treated with mono- or bimaxillary surgery and stabilization with rigid internal fixation, the maxilla was demonstrated to remain in the postsurgical position, whereas a moderate rate of mandibular relapse dependent on the amount of surgical alteration of the mandibular position was present.     

Stability of the Le Fort I osteotomy with anterior internal fixation alone: a case series.

PURPOSE: The purpose of this case series was to evaluate the late postsurgical stability of the Le Fort I osteotomy with anterior internal fixation alone and no posterior zygomaticomaxillary buttress internal fixation. PATIENTS AND METHODS: Sixty patients with maxillary vertical hyperplasia and mandibular retrognathia underwent a 1-piece Le Fort I osteotomy of the maxilla with superior repositioning and advancement or setback. A bilateral sagittal split ramus osteotomy for mandibular advancement was also performed in 22 patients. Stabilization of each maxillary osteotomy was achieved using transosseous stainless steel wires and/or 3-hole titanium miniplates in the piriform aperture region bilaterally, with no zygomaticomaxillary buttress internal fixation. (Twelve of the 60 identified patients were available for a late postoperative radiographic evaluation.) Lateral cephalometric radiographs were taken preoperatively (T1), early postoperatively (T2), and late postoperatively (T3) to analyze skeletal movement. RESULTS: These 12 patients (5 male, 7 female) had a mean age of 24.5 years at surgery. Mean time from surgery to T2 was 41.2 days; mean time from surgery to T3 was 14.8 months. One patient received anterior wire osteosynthesis fixation, while 11 patients received both anterior titanium miniplate internal skeletal fixation and anterior wire osteosynthesis fixation. Six patients underwent Le Fort I osteotomy with genioplasty, 1 patient underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy, and 5 patients underwent Le Fort I osteotomy with bilateral sagittal split ramus osteotomy and genioplasty. These 12 patients all underwent maxillary superior repositioning with either advancement (11 patients) or setback (1 patient). Statistically significant surgical (T2-T1) changes were found in all variables measured. In late postsurgical measurements (T3-T2), all landmarks in the horizontal and vertical plane showed statistically significant skeletal stability. CONCLUSION: This case series suggests that anterior internal fixation alone in cases of 1-piece Le Fort I maxillary superior repositioning with advancement has good late postoperative skeletal stability.