Long-term experience with simultaneous movement of the upper and lower jaw.

A series of 25 extreme Angle class III cases who were operated on by a combined advancement of the maxilla after Le Fort I osteotomy and retropositioning of the mandible after sagittal splitting of the rami was evaluated clinically and radiologically (mean 4 years) after the osteotomies. A very limited number of early postoperative complications and problems were found. A late follow up 22 cases showed a good or even excellent aesthetic result. Occlusion had remained absolutely stable in 17 cases, while in 4 a partial relapse to an edge to edge position of the incisors had occurred. Cephalometric X-ray analysis showed that only in one case had the maxilla move slightly back-wards, while in 5 a small relapse of the mandibular movement was seen. It is therefore concluded from this study, that a combined osteotomy of upper and lower jaw is the treatment of choice for extreme Angle class III deformities. The low complication rate, the enormous aesthetic gain and the few problems and small partial relapses seen at late follow up lead us to recommend this procedure strongly.