Journal of Maxillofacial and Oral Surgery

, Volume 18, Issue 2, pp 280–287 | Cite as

The Direction of Double-Jaw Surgery Relapse for Correction of Skeletal Class III Deformity: Bilateral Sagittal Split Versus Intraoral Vertical Ramus Setback Osteotomies

  • Ra’ed Mohammed Ayoub Al-DelaymeEmail author
  • Ali Arkan Redha Alsagban
  • Fires Taha Ahmed
  • Ahmad Farag
  • Tumouh Al-Allaq
  • Parveen Virdee
  • Zaid Alnajjar
  • Sufian Alaa Ibraheem Alsamaraie
  • Salih Elnashef
  • Layla Arab
  • Alaa Yassin
  • Moutaz AL-khen
Original Article



This prospective comparative clinical trial study aims to investigate the postoperative stability of the double-jaw surgical treatment of skeletal Class III deformity and to compare two different mandibular surgical approaches. The study goal is to locate the relapsing direction of both the maxilla and the distal segment after either bilateral sagittal split ramus osteotomy (BSSO), or intraoral vertical ramus osteotomy (IVRO).


Twenty-two (22) patients with skeletal Class III were included in this study. The patients were treated with double-jaw surgery by LeFort I osteotomy combined with either BSSO or IVRO. Lateral cephalograms taken before (T0), immediately after (T1), and 1 year after the surgery (T2) were studied and analyzed.


The mean mandibular setback and maxillary advancement in the BSSO group were 6.22 mm at B Point and 2.93 mm at A point with relapse percentages of 24.9 and 26.6%, respectively, while the mean mandibular setback and maxillary advancement in the IVRO group were 2.55 mm at B point and 5.89 mm at A point with relapse percentages of 22.1 and 23.5%, respectively. The magnitude of the setback significantly accounted for the relapse.


One-year follow-up revealed that the maxilla would be displaced posteriorly and inferiorly in both groups. Regarding the direction of the mandibular relapse, the mandible in BSSO surgical group was displaced forward and upward, while in IVRO surgical group, the directions were completely different in which the mandible is displaced backward and downward.


Class III Orthognathic surgery Relapse Bilateral sagittal split osteotomy (BSSO) Intraoral vertical osteotomy (IVRO) 


Authors’ Contribution

RA, AA, FA, and MA designed and performed the study, carried out the literature research and manuscript preparation. RA, AA, FA, MA, AF, TA, PV, SAl, ZAl, SE, AY, and LA were responsible for critical revision of scientific content and manuscript review. All authors approved the final version of the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Al-Delayme R, Al-Khen M, Hamdoon Z, Jerjes W (2013) Skeletal and dental relapses after skeletal class III deformity correction surgery: single-jaw versus double-jaw procedures. Oral Surg Oral Med Oral Pathol Oral Radiol 115:466–472CrossRefGoogle Scholar
  2. 2.
    Al-Delayme RM, Al-Khen M (2014) Skeletal relapse after mandibular setback in bi max surgery: intraoral vertical ramus versus bilateral sagittal split osteotomies. J Maxillofac Oral Surg 13:471–477CrossRefGoogle Scholar
  3. 3.
    Al-Gunaid T, Yamada K, Takagi R, Saito C, Saito I (2008) Postoperative stability of bimaxillary surgery in Class III patients with mandibular protrusion and mandibular deviation: a frontal cephalometric study. Int J Oral Maxillofac Surg 37:992–998CrossRefGoogle Scholar
  4. 4.
    Bailey LT, Proffit WR, White RP Jr (1995) Trends in surgical treatment of Class III skeletal relationships. Int J Adult Orthodon Orthognath Surg 10:108–118Google Scholar
  5. 5.
    Bell WH, Yamaguchi Y (1991) Condyle position and mobility before and after intraoral vertical ramus osteotomies and neuromuscular rehabilitation. Int J Adult Orthodon Orthognath Surg 6:97–104Google Scholar
  6. 6.
    Borstlap WA, Stoelinga PJ, Hoppenreijs TJ, van’t Hof MA (2004) Stabilisation of sagittal split advancement osteotomies with miniplates: a prospective, multicentre study with two-year follow-up. Part III—condylar remodelling and resorption. Int J Oral Maxillofac Surg 33:649–655CrossRefGoogle Scholar
  7. 7.
    Chen F, Terada K, Hua Y, Saito I (2007) Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities. Am J Orthod Dentofac Orthop 131:372–377CrossRefGoogle Scholar
  8. 8.
    Choi HS, Rebellato J, Yoon HJ, Lund BA (2005) Effect of mandibular setback via bilateral sagittal split ramus osteotomy on transverse displacement of the proximal segment. J Oral Maxillofac Surg 63:908–916CrossRefGoogle Scholar
  9. 9.
    Costa F, Robiony M, Zorzan E, Zerman N, Politi M (2006) Stability of skeletal Class III malocclusion after combined maxillary and mandibular procedures: titanium versus resorbable plates and screws for maxillary fixation. J Oral Maxillofac Surg 64:642–651CrossRefGoogle Scholar
  10. 10.
    Degerliyurt K, Ueki K, Hashiba Y, Marukawa K, Simsek B, Okabe K, Nakagawa K, Yamamoto E (2009) The effect of mandibular setback or two-jaws surgery on pharyngeal airway among different genders. Int J Oral Maxillofac Surg 38:647–652CrossRefGoogle Scholar
  11. 11.
    Fujioka M, Fujii T, Hirano A (2000) Comparative study of mandibular stability after sagittal split osteotomies: biocortical versus monocortical osteosynthesis. Cleft Palate Craniofac J 37:551–555CrossRefGoogle Scholar
  12. 12.
    Ghali GE, Sikes JW Jr (2000) Intraoral vertical ramus osteotomy as the preferred treatment for mandibular prognathism. J Oral Maxillofac Surg 58:313–315CrossRefGoogle Scholar
  13. 13.
    Hall D (1980) Intraoral vertical ramus osteotomy. In: Bell WH (ed) Surgical correction of dentofacial deformities, vol 2. Saunders, Philadelphia, pp 890–895Google Scholar
  14. 14.
    Kwon TG, Mori Y, Minami K, Lee SH, Sakuda M (2000) Stability of simultaneous maxillary and mandibular osteotomy for treatment of class III malocclusion: an analysis of three-dimensional cephalograms. J Craniomaxillofac Surg 28:272–277CrossRefGoogle Scholar
  15. 15.
    Marsan G, Oztas E, Kuvat SV, Cura N, Emekli U (2009) Changes in soft tissue profile after mandibular setback surgery in Class III subjects. Int J Oral Maxillofac Surg 38:236–240CrossRefGoogle Scholar
  16. 16.
    Mohajerani H, Mehdizadeh M, Khalighi A (2009) Skeletal relapse after correction of mandibular prognathism by bilateral sagittal split ramus osteotomy. J Dent 6(3):139–144Google Scholar
  17. 17.
    Nishioka GJ, Zysset MK, Van Sickels JE (1987) Neurosensory disturbance with rigid fixation of the bilateral sagittal split osteotomy. J Oral Maxillofac Surg 45:20–26CrossRefGoogle Scholar
  18. 18.
    Nwoku AL, Palomero-Rodriguez R, Horch HH (1974) The problems of correction of asymmetric mandibular prognathism. Int J Oral Surg 3:229–233CrossRefGoogle Scholar
  19. 19.
    Politi M, Costa F, Cian R, Polini F, Robiony M (2004) Stability of skeletal class III malocclusion after combined maxillary and mandibular procedures: rigid internal fixation versus wire osteosynthesis of the mandible. J Oral Maxillofac Surg 62:169–181CrossRefGoogle Scholar
  20. 20.
    Renzi G, Becelli R, Di Paolo C, Iannetti G (2003) Indications to the use of condylar repositioning devices in the surgical treatment of dental-skeletal class III. J Oral Maxillofac Surg 61:304–309CrossRefGoogle Scholar
  21. 21.
    Talesh KT, Motamedi MH, Sazavar M, Yazdani J (2010) Assessment of relapse following intraoral vertical ramus osteotomy mandibular setback and short-term immobilization. Eplasty pii:e54Google Scholar
  22. 22.
    Watzke IM, Heinrich A (2002) The impact of bilateral sagittal split osteotomy on mandibular width and morphology. J Oral Maxillofac Surg 60:502–504CrossRefGoogle Scholar
  23. 23.
    Westermark A, Bystedt H, von Konow L (1998) Inferior alveolar nerve function after mandibular osteotomies. Br J Oral Maxillofac Surg 36:425–428CrossRefGoogle Scholar
  24. 24.
    Wolford LM (2000) The sagittal split ramus osteotomy as the preferred treatment for mandibular prognathism. J Oral Maxillofac Surg 58:310–312CrossRefGoogle Scholar
  25. 25.
    Yoshioka I, Khanal A, Tominaga K, Horie A, Furuta N, Fukuda J (2008) Vertical ramus versus sagittal split osteotomies: comparison of stability after mandibular setback. J Oral Maxillofac Surg 66:1138–1144CrossRefGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2018

Authors and Affiliations

  • Ra’ed Mohammed Ayoub Al-Delayme
    • 1
    • 2
    • 3
    Email author
  • Ali Arkan Redha Alsagban
    • 2
    • 3
  • Fires Taha Ahmed
    • 4
  • Ahmad Farag
    • 5
  • Tumouh Al-Allaq
    • 6
  • Parveen Virdee
    • 1
  • Zaid Alnajjar
    • 6
  • Sufian Alaa Ibraheem Alsamaraie
    • 7
  • Salih Elnashef
    • 1
  • Layla Arab
    • 8
  • Alaa Yassin
    • 9
  • Moutaz AL-khen
    • 10
  1. 1.Eastman Institute for Oral HealthUniversity of Rochester, School of Medicine and DentistryNew YorkUSA
  2. 2.Faculty of DentistryDijlah University CollegeBaghdadIraq
  3. 3.Oral and Maxillofacial DepartmentAlyarmouk Teaching HospitalBaghdadIraq
  4. 4.Oral and Maxillofacial DepartmentAl-Shaheed Ghazi Al-Hariri Specialized SurgeriesBaghdadIraq
  5. 5.University of Vermont Health Network – AHMCMaloneUSA
  6. 6.Chesapeake Health CarePrincess Anne, MarylandUSA
  7. 7.Romo dentalChicagoUSA
  8. 8.Oral and Maxillofacial Surgery DepartmentUniversity of WashingtonSeattleUSA
  9. 9.Graduate Periodontics DepartmentUniversity of WashingtonSeattleUSA
  10. 10.Oral and Maxillofacial DepartmentDamascus HospitalDamascusSyria

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