Mandibular Changes Research Articles

Description of Mandibular Improvements in a Series of Infants With Congenital Muscular Torticollis and Deformational Plagiocephaly Treated With Physical Therapy.

Many infants with congenital muscular torticollis (CMT) have deformational plagiocephaly (DP), and a small cohort also demonstrate mandibular asymmetry (MA). The aim of this retrospective study was to evaluate mandibular changes in these infants with previous computed tomography (CT) scans who underwent physical therapy (PT) to treat CMT. A retrospective study included patients presenting to a pediatric plastic surgery clinic from December 2010 to June 2012 with CMT, DP, and MA. A small subset of these patients initially received a 3D CT scan due to concern for craniosynostosis. An even smaller subset of these patients subsequently received a second 3D CT scan to evaluate for late-onset craniosynostosis. Patients were treated with PT for at least 4 months for CMT. Initial CT scans were retrospectively compared to subsequent CT scans to determine ramal height asymmetry changes. Clinical documentation was reviewed for evidence of MA changes, CMT improvement, and duration of PT. Ten patients met inclusion criteria. Ramal height ratio (affected/unaffected) on initial CT was 0.87, which significantly improved on subsequent CT to 0.93 ( P < .05). None of the patients were diagnosed with craniosynostosis on initial CT. One patient was diagnosed with late-onset coronal craniosynostosis on subsequent CT. We identified a small cohort of infants with MA, CMT, and DP. These patients uniformly demonstrated decreased ramal height ipsilateral to the affected sternocleidomastoid muscle. Ramal asymmetry measured by ramal height ratios improved in all infants undergoing PT.

Unilateral nasal obstruction induces morphological changes of the mandibular condyle in growing rats

PurposeChronic nasal obstruction is known to decrease blood oxygen saturation. Mouth breathing in association with chronic nasal obstruction leads to the collapse of the buccinator mechanism and to a clockwise rotation of the mandible, which causes mandibular retrusion. This study aimed to investigate the influences of nasal obstruction on the morphological and histological changes of the mandible in growing rats. Materials and methodsThirty 8-day-old male Wistar rats were randomly divided into the control and experimental groups. The experimental group underwent unilateral nasal obstruction by cauterization of the external nostrils at 8days of age. Pulse oxygen saturation (SpO2) was monitored every week. Rats were sacrificed at 9 weeks of age. The mandibular changes were analyzed via lateral cephalometric radiographs and micro-CT scans. We utilized toluidine blue and tartrate-resistant acid phosphatase (TRAP) staining for histological analysis. Immunohistochemical staining of hypoxia induced factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), osteoprotegerin (OPG) receptor activator of nuclear factor kappa-B ligand (RANKL) were also performed to reveal the mechanism of the morphological changes. ResultsSpO2 was significantly lower in the experimental than in the control group. In the experimental group, length, bone mineral density and cartilage layer thickness of mandibular condyle were decreased. The number of TRAP-positive cells in the condyle, HIF-1α-positive cells, VEGF-positive cells and RANKL-positive cells in the condylar cartilage was significantly increased. In contrast, a reduced expression of OPG protein was observed in the experimental group. ConclusionsOur findings suggest that unilateral nasal obstruction in the growth period affects mandibular morphology.

Detection of mandibular cortical change using computer-assisted diagnosis system on panoramic radiography

Detection of mandibular cortical change using computer-assisted diagnosis system on panoramic radiography

Volumetric mandibular change after angle ostectomy and outer cortex grinding

BackgroundMandibular angle ostectomy is one of the most common surgical procedures for facial contouring in Asian women. However, some patients complain about mandibular angle hypertrophy recurrence after surgery. The present study evaluated volumetric change of the mandible after angle ostectomy and outer cortex grinding. MethodsTwenty-four patients who underwent bilateral mandibular angle ostectomy and outer cortex grinding from 2013 to 2016 were enrolled. Three-dimensional computed tomography data were used to evaluate the preoperative, immediate postoperative, and long-term follow-up (≥12 months) volume of the mandible. The volumetric change between different groups was analyzed. ResultsThe results of software measurements showed that the preoperative mandible volume was significantly larger than immediate and long-term postoperative volumes (P = 0.000), and there was no significant difference between immediate and long-term postoperative mandibular volume (P > 0.05). Mean bone regeneration at long-term follow-up was 1.42% ± 3.84% for those who underwent mandibular angle ostectomy with outer cortex grinding alone and 1.69% ± 2.45% on the left and 2.59% ± 3.61% on the right sides of patients who underwent this procedure along with advancement genioplasty. ConclusionMandibular angle ostectomy can effectively change the facial contour to achieve a more oval-shaped face favored by most Asians. Postoperative bone remodeling is mostly regenerated, although bone absorption did occur. However, the mean bone volume did not reach preoperative levels, and the difference between preoperative and long-term postoperative bone volume at follow-up (≥12 months) was significant.

Temporomandibular joint positional change accompanies post-surgical mandibular relapse-A long-term retrospective study among patients who underwent mandibular advancement.

This study evaluated the relationship between follow-up temporomandibular joint positional change and mandibular stability among patients who had orthognathic and orthodontic treatment for a skeletal Class II malocclusion. Thirty-seven patients who underwent 2-jaw surgery (Le Fort I osteotomy, bilateral sagittal split ramus osteotomy and genioplasty with rigid internal fixation) were included with an average follow-up length of 8.10±2.06years. They were categorized into a stable and unstable group according to follow-up mandibular change in the sagittal direction. Temporomandibular joint spaces were measured on serial magnetic resonance images, prior to orthodontic treatment (T0), upon completion of orthodontic treatment following surgery (T1), and at least 5years post-completion of the treatment (T2). While the maxillary position was stable during the follow-up period, the mandibular positional change was statistically significant (the relapse amount was -0.81±1.52mm at B point). An increase in the anterior joint space and superior joint space was found to correlate with the follow-up mandibular backward movement. Patients who underwent orthognathic and orthodontic treatment to correct mandibular retrognathism displayed follow-up mandibular relapse in the sagittal direction. The relapse is accompanied by condylar positional change.

Analysis of mandibular changes using panoramic-based indices in patients with chronic renal failure.

Chronic renal failure (CRF) is a progressive disease affecting many systems and causing dental and periodontal problems, in particular a decrease or loss in the amount of cortical bone that is visible on radiographs. Panoramic radiography is useful for determining these changes. The aim of this study was to evaluate cortical parts of the mandible using panoramic-based indices in patients with CRF. 70 subjects with CRF were included in the study. The measurements of panoramic indices were made according to the visibility (mandibular cortical index, MCI) and thickness (mental index, MI) of the inferior cortex of the mandible. Then, these indices, obtained from 70 healthy controls of the same age and gender, were assessed and the results were compared. The effects of dental status and hemodialysis duration on MCI and MI were also investigated. The frequency of an eroded cortex was significantly elevated in patients with CRF (p<0.05). The mean MI was lower in patients with CRF than in healthy subjects (5.53 ± 1.62 and 5.73 ± 1.31 mm, respectively), but the difference was not statistically significant (p>0.05). No correlation was found between hemodialysis duration and mandibular indices (p>0.05). Dental status was not associated with mandibular indices (p>0.05). These results suggest that MCI might be a useful radiographic parameter for evaluating changes occurring in the cortical parts of the mandible in CRF patients. Clinicians should be aware of these changes while planning invasive dental treatments in CRF patients.

A Novel Method to Detect 3D Mandibular Changes Related to Soft-Diet Feeding.

Craniofacial morphology varies among individuals, which is regulated by the interaction between genes and the environment. Soft-diet feeding is a widely-used experimental model for studying the association between the skeletal morphology and muscle-related loading on the bone. Traditionally, these studies have been based on linear and angular measurements provided on two-dimensional (2D) radiographs in the lateral view. However, 2D observation is based on simplification of the anatomical structures and cannot detect three-dimensional (3D) changes in detail. In this study, we newly developed a modified surface-based analysis with micro-3D computed tomography (CT) to examine and detect the 3D changes in the mandible associated with soft-diet feeding. Mice at 3 weeks of age were fed a powdered soft-diet (SD) or hard-diet (HD) of regular rodent pellets until 9 weeks of age. Micro-CT images were taken at age 9 weeks to reconstruct the anatomical architecture images. A computer-generated averaged mandible was superimposed to directly visualize the morphological phenotypes. Gross observation revealed the apparent changes at the posterior body of the mandible, the angular process and the condyle between HD and SD mice. Significant differences in the mapping indicated the regions of significant displacement in the SD mice over the averaged 3D image of the HD mice. This map revealed that vertical displacement was most evident in 3D changes. We also noted a combination of vertical, transverse and anteroposterior directions of displacement in the condylar growth, resulting in complicated shape changes in the whole condylar process in SD mice. In contrast, transverse displacement was more significant in the coronoid process. The map analysis further showed the significant outward displacement of the inner surface of the alveolar process, which consequently resulted in thinning of the alveolar process.

Mandibular Incisor Position Changes do not Explain Increase in Keratinized Gingiva Height after Periodontally Accelerated Osteogenic Orthodontics

Purpose This study aimed to reexamine the relationship between mandibular incisor inclination, prominence and vertical changes in position, and keratinized gingival tissue (KT) height changes labial to the mandibular incisors after orthodontic treatment with and without augmented corticotomy (Cort). Materials and Methods Two orthodontically treated groups of 35 individuals each, with (Cort) and without (conventional [Conv]) alveolar decortication and augmentation bone grafting (periodontally accelerated osteogenic orthodontics [PAOO]), were matched for sample size, gender, mandibular premolar extractions, pretreatment age, posttreatment observation period, and pretreatment KT height in this case–controlled retrospective study. Pre- and post-treatment lateral cephalometric radiographs were evaluated for mandibular incisor vertical, inclination, and prominence changes. Results As reported previously (Wilcko 2015), KT height had significantly increased by 0.78 mm (P = 0.001) in the Cort group and decreased by 0.38 mm (P = 0.002) in Conv on an average of 1.5 years after completion of active orthodontic therapy. In this study, Cort mandibular incisors proclined and protruded significantly during therapy while Conv incisors did not. Changes in mandibular incisor inclination and prominence explained neither the decrease in keratinized gingiva height in Conv nor the KT height gain in Cort. Conclusions In spite of mandibular incisor proclination and protrusion, orthodontic therapy combined with alveolar decortication and augmentation bone grafting resulted in a clinically significant increase in keratinized gingiva height 1.5 years’ posttreatment.

Three-dimensional skeletal mandibular changes associated with Herbst appliance treatment.

Three-dimensional evaluation of skeletal mandibular changes following Herbst appliance treatment. Retrospective case-control study, based on a sample size calculation. Twenty-five pubertal patients treated with Herbst appliance (HAG), and 25 matched Class II patients who received other non-orthopaedic dental treatments (CG). Three-dimensional models were generated from pre-treatment (T0) and post-treatment (T1) cone beam computed tomograms. Volumetric registration on the cranial base was used to assess mandibular displacement; volumetric regional registration was performed to evaluate mandibular growth. Quantitative measurements of X, Y, Z and 3D Euclidian changes, and also qualitative visualization by colour-mapping and semi-transparent overlays were obtained. Downward displacement of the mandible was observed in both HAG and CG (2.4mm and 1.5mm, respectively). Significant forward displacement of the mandible was observed in the HAG (1.7mm). HAG showed greater 3D superior and posterior condylar growth than the CG (3.5mm and 2.0mm, respectively). Greater posterior growth of the ramus was noted in the HAG than in CG. Immediately after Herbst therapy, a significant mandibular forward displacement was achieved, due to increased bone remodelling of the condyles and rami compared to a comparison group. Three-dimensional changes in the direction and magnitude of condylar growth were observed in Herbst patients.

Ameliorative effect of black grape juice on systemic alterations and mandibular osteoradionecrosis induced by whole brain irradiation in rats

Purpose: Whole brain irradiation (WBI) causes a variety of secondary side-effects including anorexia and bone necrosis. We evaluated the radiomodifying effect of black grape juice (BGJ) on WBI alterations in rats measuring food and water intake, body weight, hemogram, and morphological and histological mandibular parameters.Materials and methods: Forty male rats (200–250 g) were exposed to eight sessions of cranial X-ray irradiation. The total dose absorbed was 32 Gy delivered over 2 weeks. Four groups were defined: (i) NG: non-irradiated, glucose and fructose solution-supplemented (GFS); (ii) NJ: non-irradiated, BGJ-supplemented; (iii) RG: irradiated, GFS-supplemented; and (iv) RJ: irradiated, BGJ-supplemented. Rats received daily BGJ or GFS dosing by gavage starting 4 days before, continuing during, and ending 4 days after WBI.Results: RJ rats ingested more food and water and showed less body weight loss than RG rats during the irradiation period. Forty days after WBI, irradiated animals started losing weight again compared with controls as a consequence of masticatory hypofunction by mandibular osteoradionecrosis (ORN). Osteoclastic activity and inflammation were apparent in RG rat mandibles. BGJ was able to attenuate the severity of ORN as well as to improve white and red blood cell counts.Conclusions: Fractionated whole brain irradiation induces mandibular changes that interfere with normal feeding. BGJ can be used to mitigate systemic side-effects of brain irradiation and ORN.

Mandibular and glenoid fossa changes after bone-anchored maxillary protraction therapy in patients with UCLP: A 3-D preliminary assessment.

To assess mandibular and glenoid fossa (GF) changes after bone-anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). The cleft group (CG) comprised 19 patients with (mean initial age of 11.8 years). The noncleft group (NCG) comprised 24 patients without clefts (mean initial age of 11.7 years). Both groups had Class III malocclusion and were treated with BAMP therapy for 18 and 12 months, respectively. Cone-beam computed tomography (CBCT) exams were performed before and after treatment and superimposed on the anterior cranial fossa (ACF). Mandibular rotations and three-dimensional linear displacements of the mandible and GF were quantified. A t-test corrected for multiple testing (Holm-Bonferroni method) and a paired t-test were used to compare, respectively, the CG and NCG and cleft vs noncleft sides (P < .05). Immediately after active treatment, the GF was displaced posteriorly and laterally in both groups relative to the ACF. The overall GF changes in the CG were significantly smaller than in the NCG. Condylar displacement was similar in both groups, following a posterior and lateral direction. The gonial angle was displaced similarly posteriorly, laterally, and inferiorly in both groups. The intercondylar line rotated in opposite directions in the CG and NCG groups. In the CG, most changes of the GF and mandible were symmetrical. Overall GF and mandibular changes after BAMP therapy were similar in patients with and without clefts. The exception was the posterior remodeling of the GF that was slightly smaller in patients with UCLP.

Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery

To evaluate the effect of genioplasty on the size of the pharyngeal airway space (PAS) in a sample of patients without obstructive sleep apnea syndrome (OSAS) undergoing maxillomandibular advancement (MMA) surgery. Lateral cephalometric radiographs of 52 patients who underwent orthognathic surgery for MMA were obtained before (T1) and after (T2) surgery. The radiographs were digitized and the anteroposterior dimensions of the PAS were measured at the nasopharynx, oropharynx, and hypopharynx levels. The sample was divided into 2 groups: MMA with genioplasty (n= 27; average age, 30.81yr) and without genioplasty (n= 25; average age, 37.64yr). Comparisons were made between T1 and T2 in patients with and without genioplasty. Horizontal and vertical changes of the maxilla, mandible, and chin were correlated to changes in the PAS. MMA resulted in an increased anteroposterior PAS at the 3 levels analyzed (P < .05), except in the hypopharynx, in cases without genioplasty (P= .141). When the groups with and without genioplasty were compared, there were no significant differences (P > .05) in the PAS. There was a statistically relevant correlation between horizontal mandibular change and the oropharynx (r= 0.484 and r= 0.509, respectively) and between vertical chin change and the hypopharynx (r= 0.434 and r= 0.455, respectively) for groups with and without genioplasty. There was a statistically relevant correlation between horizontal chin change and the hypopharynx (r= 0.586) for surgeries without genioplasty. Considering the limitations inherent to retrospective study designs, the results suggested that MMA surgery, with and without advancement genioplasty, can promote immediate gains to the PAS. A larger gain was possible in the hypopharynx for MMA with genioplasty. MMA without genioplasty could represent a greater gain in the nasopharynx and oropharynx. Further studies should evaluate functional parameters in patients with OSAS to measure the possible benefits of this increase in the PAS.

Relationship between the cranial base and the mandible in artificially deformed skulls.

There is controversy regarding the relationship between mandibular position and alterations of the cranial base that provoke a more anterior location of the glenoid fossa. Artificially deformed skulls display marked alterations of the cranial base. This study evaluates mandibular changes as function of the morphology of the cranial base in these skulls. A geometric morphometric study was performed on lateral cephalometric X-rays of three groups of skulls: 32 with anteroposterior deformity, 17 with circumferential deformity and 39 with no apparent deformity. In artificially deformed skulls, the cranial base was deformed causing the mandibular condyle to be in a more anterior position. There was a complete remodelling of the mandible involving narrowing and elongation of the mandibular ramus, rotation of the corpus of the mandible and increased vertical height of the symphysis. Forward displacement did not occur. Integration between mandible and cranial base is not altered by deformation of the skull. Deformity of the cranial vault exerts an influence on the mandible, supporting the theory of modular units in complete integration. This also supports the theory that mandibular prognathism is a multifactorial result and not a direct effect of displacement of the cranial base.

Osteoporotic mandibular changes caused by type 2 diabetes mellitus: a comparative study by cone beam computed tomography imaging

Objectives Studies on bone mineral density and fracture risk in diabetic patients have attracted interest in the last few years. This study was aimed at comparing mandibular osteoporotic changes assessed by qualitative and quantitative radiographic methods in the mandibles of type 2 diabetes mellitus patients with those of non-diabetic subjects using cone beam computed tomographic images.

Thin-plate spline analysis of mandibular shape changes induced by functional appliances in Class II malocclusion : A long-term evaluation.

The purpose of this work was to evaluate the long-term morphological mandibular changes induced by functional treatment of Class II malocclusion with mandibular retrusion. Forty patients (20 females, 20 males) with Class II malocclusion consecutively treated with either a Bionator or an Activator followed by fixed appliances were compared with a control group of 40 subjects (19 females, 21 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start of treatment (T1, mean age 9.9years), at the end of treatment with functional appliances (T2, mean age 12.2years), and for long-term follow-up (T3, mean age 18.3years). Mandibular shape changes were analyzed on lateral cephalograms of the subjects in both groups via thin-plate spline (TPS) analysis. Shape differences were statistically analyzed by conducting permutation tests on Goodall F statistics. In the long term, both the treated and control groups exhibited significant longitudinal mandibular shape changes characterized by upward and forward dislocation of point Co associated with a vertical extension in the gonial region and backward dislocation of point B. Functional appliances induced mandible's significant posterior morphogenetic rotation over the short term. The treated and control groups demonstrated similar mandibular shape over the long term.

Fixed functional appliances with multibracket appliances have no skeletal effect on the mandible: A systematic review and meta-analysis.

Our aim was to assess the skeletal mandibular changes (anteroposterior and vertical) in circumpubertal patients with fixed functional appliances installed on multibracket appliances compared with untreated patients. An open-ended electronic search of 4 databases (PubMed, Embase, Cochrane Library, and Web of Science) up to April 2014 was performed. Additional searches of relevant journals, reference lists of the retrieved articles, systematic reviews, and gray literature were performed. Specific inclusion and exclusion criteria were applied to identify relevant articles. Quality was evaluated using the Cochrane Collaboration risk of bias tool and the Newcastle-Ottawa scale for prospective controlled clinical trials. Meta-analyses were conducted with fixed and random effects models as appropriate. Statistical heterogeneity was also examined. Seven articles were included in the qualitative synthesis and 5 in the meta-analysis. The included randomized controlled trials were at high risk of bias, and the methodologic quality of the prospective controlled clinical trials was high. Based on assessment of the fixed functional appliance phase in isolation, no difference in mandibular anteroposterior positionalchanges (SNB angle) (standard mean difference, 0.11°; 95% CI, -0.28, 0.50) was found between the treated and control groups. The vertical dimension was not influenced by the fixed functional appliance treatment. There is little high-quality evidence concerning the relative influence of fixed functional appliances on skeletal and dentoalveolar changes. However, based on the limited evidence, it appears that they have little effect on the skeletal mandibular parameters.

Mandibular changes on panoramic imaging after head and neck radiotherapy

Changes to the radiographic appearance of the jaws after head and neck radiotherapy have not been thoroughly characterized. This retrospective study examines changes to the appearance of the mandible on panoramic images following intensity-modulated radiotherapy (IMRT) and relates these changes to medical co-morbidities and radiation dose. The medical and dental charts, and panoramic images of 126 patients who received IMRT at the Princess Margaret Hospital between January 1, 2005, and December 31, 2008, were analyzed independently by three observers. Of the 126 patients, 75 (60%) had post-IMRT changes, as seen on panoramic images; most, 66 (88%), consisted of widened periodontal ligament space (WPLS). The median time to WPLS was 29months after IMRT. Female gender and radiation dose correlated with decreased time to WPLS. These results indicate that WPLS is a common radiographic sequela after head and neck radiotherapy, underscoring its clinical significance as a reliable marker of irradiated bone. Furthermore, this type of WPLS needs to be differentiated from odontogenic inflammatory disease and cancer recurrence to avoid unnecessary treatment that may precipitate osteoradionecrosis.

Major factors contributing to anterior and posterior relapse after intraoral vertical ramus osteotomy.

The aim of this retrospective cohort study was to investigate the factors contributing to mandibular relapse after intraoral vertical ramus osteotomy (IVRO) while controlling for possible confounders. Forty-seven patients who underwent bimaxillary surgery were divided into three groups according to the direction of horizontal mandibular relapse: a stable group (group S), a posterior relapse group (group P), and an anterior relapse group (group A). Lateral cephalograms were analysed 1 month before and at 7 days and 12 months after surgery. One month before surgery, the pogonion in group A was positioned about 13mm more anteriorly than in group P (P<0.05). Immediately after surgery, the mandibles in groups A and S had moved about 6mm more posteriorly than in group P. At 12 months, both the mandibles (point B) and the maxillae (point A) had moved posteriorly in group P (P<0.05). A multivariate linear regression analysis showed that the amount of setback was the one key factor predicting postoperative mandibular changes 12 months after IVRO. As the amount of setback decreased, mandibular posterior horizontal relapse increased after IVRO. These findings suggest that the amount of setback can be a key factor predicting postoperative mandibular relapse.

Growth trajectories in the cave bear and its extant relatives: an examination of ontogenetic patterns in phylogeny.

BackgroundThe study of postnatal ontogeny can provide insights into evolution by offering an understanding of how growth trajectories have evolved resulting in adult morphological disparity. The Ursus lineage is a good subject for studying cranial and mandibular shape and size variation in relation to postnatal ontogeny and phylogeny because it is at the same time not diverse but the species exhibit different feeding ecologies. Cranial and mandibular shapes of Ursus arctos (brown bear), U. maritimus (polar bear), U. americanus (American black bear), and the extinct U. spelaeus (cave bear) were examined, using a three-dimensional geometric morphometric approach. Additionally, ontogenetic series of crania and mandibles of U. arctos and U. spelaeus ranging from newborns to senile age were sampled.ResultsThe distribution of specimens in morphospace allowed to distinguish species and age classes and the ontogenetic trajectories U. arctos and U. spelaeus were found to be more similar than expected by chance. Cranial shape changes during ontogeny are largely size related whereas the evolution of cranial shape disparity in this clade appears to be more influenced by dietary adaptation than by size and phylogeny. The different feeding ecologies are reflected in different cranial and mandibular shapes among species.ConclusionsThe cranial and mandibular shape disparity in the Ursus lineage appears to be more influenced by adaptation to diet than by size or phylogeny. In contrast, the cranial and mandibular shape changes during postnatal ontogeny in U. arctos and U. spelaeus are probably largely size related. The patterns of morphospace occupation of the cranium and the mandible in adults and through ontogeny are different.Electronic supplementary materialThe online version of this article (doi:10.1186/s12862-015-0521-z) contains supplementary material, which is available to authorized users.

Bone and Soft Tissue Changes after Two-Jaw Surgery in Cleft Patients.

BackgroundOrthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery).MethodsTwenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared.ResultsThe mean horizontal advancement of the maxilla (point A) was 6.12 mm, while that of the mandible (point B) was -5.19 mm. The mean point A-nasion-point B angle was -4.1° before surgery, and increased to 2.5° after surgery. The mean nasolabial angle was 72.7° before surgery, and increased to 88.7° after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'.ConclusionsPatients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A') was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.