Class III skeletal pattern with maxillary deficiency and mandibular excess
22-year-old male
§Chief complaint
Prominent lower jaw, difficulty biting with front teeth, unhappy with facial appearance
§Medical & dental history
- 01Healthy, growth complete (stable hand-wrist and serial cephalograms)
- 02Pre-surgical orthodontics for 18 months to decompensate the incisors
§Clinical examination
- 01Concave profile with flat mid-face and prominent chin
- 02Reverse overjet of -6 mm, anterior crossbite, class III molar relationship
- 03Lower dental midline 2 mm to the left; no TMJ symptoms
§ figuresFigures (2)
Fig. 1Pre and post Orthodontics were done by Dr, Vipin Challiyil and Orthognathic surgery was done by Dr. Aju Ommen .
“Orthognathic surgery” · Challiyan · CC BY-SA 4.0 · Wikimedia Commons
Fig. 2Osteotomies of the maxilla and mandible. 1. Lefort I 2. Bilateral sagittal split 3. Genioplasty
“Orthognatic surgery” · Henry Grey · Public domain · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Orthognathic Surgery figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Skeletal class III malocclusion due to maxillary hypoplasia and mandibular prognathism
Cephalometric analysis (SNA 76°, SNB 84°, ANB -8°) and the facial profile show both jaws are responsible, so a two-jaw operation gives the best balance.
§Investigations
- 01Lateral cephalogram and posteroanterior cephalogram
- 02CBCT and intraoral scans for virtual surgical planning
- 03Facial photographs; psychological readiness assessment
§Radiology
- 01Cephalogram — ANB -8°, normal vertical proportions
- 02CBCT — symmetrical condyles; inferior alveolar canal positions mapped for the split
§Treatment plan
- 01Pre-surgical orthodontics to decompensate
- 02Bimaxillary surgery: Le Fort I advancement 5 mm and bilateral sagittal split setback 4 mm
- 03Post-surgical orthodontics for 6-9 months
§Surgical procedure
- 01Virtual surgical plan with printed intermediate and final splints
- 02Le Fort I osteotomy, down-fracture, advancement and fixation with four L-plates
- 03Bilateral sagittal split osteotomies, mandible set back into the final splint and fixed with plates
§Follow-up & outcome
- 01Week 1 — light guiding elastics, mild lip numbness
- 02Month 3 — stable occlusion; sensation returning
- 03Month 12 — stable result, orthodontics complete
Outcome: Class I occlusion with balanced profile; lip sensation recovered at 9 months.
§Discussion
- 01Inferior alveolar nerve disturbance is the commonest problem after sagittal split, usually temporary.
- 02Virtual planning improves accuracy and lets the team review soft tissue predictions with the patient.
§Clinical pearls / learning points
- 01Surgery should wait until growth has stopped in class III cases.
- 02Decompensate the teeth first so the jaws can move the full distance.
§Viva questions
Why decompensate before surgery?
Teeth have tilted to mask the skeletal problem; uprighting them reveals the true discrepancy so the jaws can be moved fully.
§MCQs
Q1The commonest complication of bilateral sagittal split osteotomy is:
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L3 · Systematic review — 1
- L6 · Textbook — 4
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Systematic Reviews & Meta-Analyses
Wang M, Zhang B, Li L et al.. European journal of orthodontics · 2022 · 44(1):1-10
Systematic review of vertical skeletal stability across orthognathic treatment protocols.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Hupp JR, Ellis E, Tucker MR. Elsevier · 2019
Core surgical textbook covering exodontia, infection, trauma and preprosthetic surgery.
Additional sources cited on this page
- Proffit WR, White RP, Sarver DM. Contemporary Treatment of Dentofacial Deformity.
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