Vertical Ramus Osteotomy Research Articles

Correlation between the Pharyngeal Airway Space and Head Posture after Surgery for Mandibular Prognathism.

Purpose. The aim of this study was to determine the correlation between the pharyngeal airway space and head posture after mandibular setback surgery for mandibular prognathism. Materials and Methods. Serial lateral cephalograms of 37 patients with mandibular prognathism who underwent intraoral vertical ramus osteotomy (IVRO) were evaluated before (T1) and immediately (T2), between 6 weeks and 3 months (T3), and more than 1 year (T4) after surgery. Paired t-tests and Pearson's correlation analysis were used to evaluate the postoperative changes in all cephalometric parameters, including the mandible, hyoid, head posture (craniocervical angle), and pharyngeal airway space. Results. The mandible and hyoid were set back by 12.8 mm and 4.9 mm, respectively, at T2. Furthermore, the hyoid showed significant inferior movement of 10.7 mm, with an 8 mm increase in the tongue depth. The upper oropharyngeal airway (UOP) shortened by 4.1 mm, the lower oropharyngeal airway (LOP) by 1.7 mm, and the laryngopharyngeal airway by 2 mm. The craniocervical angle showed a significant increase of 2.8°. UOP and LOP showed a significant correlation with the craniocervical angle at T2 and T4. Conclusions. Our findings conclude that the oropharyngeal airway space is significantly decreased and correlated with a change in the head posture after mandibular setback surgery.

Intraoperative Hemorrhage and Postoperative Sequelae after Intraoral Vertical Ramus Osteotomy to Treat Mandibular Prognathism.

Objective. To investigate the factors affecting intraoperative hemorrhage and postoperative sequelae after orthognathic surgery. Materials and Methods. Eighty patients with mandibular prognathism underwent surgical mandibular setback with intraoral vertical ramus osteotomy (IVRO). The correlation between the blood loss volume and postoperative VAS with the gender, age, and operating time was assessed using the t-test and Spearman rank correlation coefficient. The correlation between the magnitude of mandibular setback with the presence of TMJ clicking symptoms and lip sensation was also assessed. Results. The mean operating time and blood loss volume for men and women were 249.52 min and 229.39 min, and 104.03 mL and 86.12 mL, respectively. The mean VAS in men and women was 3.21 and 2.93, and 1.79 and 1.32 on the first and second postoperative days. There is no gender difference in the operating time, blood loss, VAS, TMJ symptoms, and lip numbness. The magnitude of mandibular setback was not correlated with immediate and long-term postoperative lip numbness. Conclusion. There are no gender differences in the intraoperative hemorrhage and postoperative sequelae (pain, lip numbness, and TMJ symptoms). In addition, neither symptom was significantly correlated with the amount of mandibular setback.

Facial Nerve Palsy following Mandibular Setback: A Case Report and Review of the Literature

Introduction: Mandibular prognathism is a common dentofacial deformity that is often treated with orthognathic surgery (jaw straightening or corrective jaw surgery). The two most common types of operations to correct mandibular prognathism are the mandibular bilateral sagittal split osteotomy (BSSO) and/or the intraoral vertical ramus osteotomy (IVRO). Although there are other surgeries that exist to correct this type of deformity, the BSSO and IVRO are the most commonly used treatment options. The advantages and disadvantages to each of these procedures are generally well documented in the literature. However, facial nerve palsy is an infrequent and less commonly reported complication of these two types of surgeries. We provide a case report of one such instance of total unilateral facial nerve palsy following mandibular BSSO. Materials and Methods: A 20-year-old man with mandibular prognathism underwent mandibular setback surgery via a bilateral mandibular sagittal split osteotomy. His surgery was complicated by a right-sided mandibular buccal plate fracture intraoperatively and a severe unilateral right-sided cranial nerve VII palsy postoperatively. Results: While still admitted to the hospital, the patient was noted to have a right-sided palsy of all branches of the facial nerve. This facial nerve palsy continued to persist on an outpatient basis, although the patient ultimately had full resolution of his right-sided facial nerve palsy at 10 months postoperatively. Conclusions: The complication of facial nerve palsy may be devastating to a patient, especially when the procedure is deemed elective. Although the exact mechanism is unknown, facial nerve palsy secondary to mandibular surgery is most likely related to the close proximity of the field of operation to the anatomy of the facial nerve. This assumption is supported by the lack of documented cases of facial nerve palsy from maxillary orthognathic surgery. Although rare, the authors feel that the risk of facial nerve injury should be discussed with the patient when mandibular surgery is planned.

Distúrbios neurossensoriais associados ao nervo alveolar inferior após a osteotomia vertical intraoral dos ramos mandibulares

O objetivo deste estudo foi avaliar os indices de lesao ao nervo alveolar inferior (NAI), apos a realizacao da osteotomia vertical intraoral dos ramos mandibulares (OVIRM) para correcao do prognatismo mandibular, comparando-os com os relatos da literatura. A amostra foi composta de dez pacientes, escolhidos aleatoriamente, submetidos a OVIRM, associada ou nao a osteotomia da maxila. Nao houve casos de danos ao NAI na amostra apos um ano de acompanhamento. A OVIRM demonstrou ser uma tecnica cirurgica segura e previsivel em relacao ao NAI, desde que suas peculiaridades sejam respeitadas. DOI: 10.18363/rbo.v71i1.534

Retrospective study of changes in the sensitivity of the oral mucosa: sagittal split ramus osteotomy (SSRO) versus intraoral vertical ramus osteotomy (IVRO)

We investigated changes in the sensitivity of cutaneous points and the oral mucosa after sagittal split ramus osteotomy (SSRO) and assessed the differences between SSRO and intraoral vertical ramus osteotomy (IVRO). The subjects included in this study were 46 patients with mandibular prognathism who underwent IVRO (88 rami) and 30 patients who underwent SSRO (59 rami). An objective evaluation of the neurosensory status of each patient was completed preoperatively and at 1, 4, 8, 12, and 24 weeks postoperatively. Other variables studied for each patient included sex, age, magnitude of mandibular setback, and amount of blood loss during surgery. We found that a neurosensory recovery occurred earlier in the oral mucosa than at cutaneous points. The number of oral mucosa points showing reduced neurosensory function and neurosensory disturbance after SSRO was significantly higher than after IVRO at 1, 4, and 8 weeks (P<0.05). The nerve recovery observed after SSRO was delayed for a longer period than that noted in our previous study of IVRO. In conclusion, we found changes in sensitivity at cutaneous points and the oral mucosa after SSRO and assessed the differences between SSRO and IVRO.

Intraoral Vertical Ramus Osteotomy for Correction of Mandibular Deformity

Complication after Extraoral Vertical and Intraoral Oblique Osteotomy have been reported but in a comprehensive manner. Although intuitively the profile of complications after Intra Oral Vertical Ramus Osteotomy (IVRO) would be similar to subcondylar osteotomy, the technique of the two procedures are different, and thus unfavorable outcome after surgery also may differ. The aim of this study was evaluate the morbidity and complications following correcton of mandibular deformity by IVRO.

A Comparative Study of the Changes in Condylar Position after Mandibular Setback Using Bilateral Sagittal Split Ramus Osteotomy between Surgery-After and Surgery-First Orthognathic Surgery

Statement of the Problem: Complication after Extraoral Vertical and Intraoral Oblique Osteotomy have been reported but in a comprehensive manner. Although intuitively the profile of complications after Intra Oral Vertical Ramus Osteotomy (IVRO) would be similar to subcondylar osteotomy, the technique of the two procedures are different, and thus unfavorable outcome after surgery also may differ. The aim of this study was evaluate the morbidity and complications following correcton of mandibular deformity by IVRO. Material and Method: A prospective study was undertaken of 271 consecutively treated orthognathic surgical patients with mandibular deformity(without mandibular deficiency). Each patients was treated by bilateral IVRO with 2 Weeks of maxillo-mandibular fixation and no interosseous fixation of proximal segment. Method of Data Analysis: Postoperative stability ,immediately after surgery ,at 6 months , and at 12 months after surgeryweremade. Complications consist of vascular complications, nerve injury, infection, condylar luxation andbonehearingwere assessedby retrospective individual chart review. Results: The mean blood loss was 47g and no severe bleeding during operation. There was no wound infection and avascular necrosis after surgery. Inferior alveolar nerve neurosensory disturbance remained 2 operative sites but was not permanent. Malocclusion after surgery was manifest by either relapse or anterior open bite occurred in 3 patients. Condylar dislocation occurred 1 patient. Conclusion: Our studies indicated that surgical correction of mandibular deformity by IVRO had a beneficial effect not only on occlusion but also upon complication after surgery.

Clinical study of the complications at proximal segment with intraoral vertical ramus osteotomy (IVRO); related to the osteotomy line?

The intraoral vertical ramus osteotomy (IVRO) is widely used to correct mandibular prognathism and has several advantages over the sagittal split ramus osteotomy such as ease of procedure, reduced surgical time, minimal incidence of inferior alveolar nerve injury and less adverse events of the temporomandibular joint. However, several reports have been indicated IVRO technique has disadvantages such as condylar luxation and an interference of proximal segment. We hypothesize that these complications are related to the osteotomy line of IVRO. To evaluate this hypothesis, we investigated the incidence of condylar luxation and the interference of proximal segment following bilateral or unilateral IVRO focused on the osteotomy line.

Correlation analysis of three-dimensional changes of hard and soft tissues in class III orthognathic surgery patients using cone-beam computed tomography.

This study was to investigate the correlation between changes of the soft and hard tissues three-dimensionally in class III orthognathic patients using cone-beam computed tomography. Cone-beam computed tomography images were obtained within 2 weeks before surgery and at 6 months after surgery in 18 adult class III patients who underwent Le Fort I osteotomy and bilateral intraoral vertical ramus osteotomy. Subjects were divided into group 1 with no mandibular asymmetry (menton deviation, <2 mm; n = 9) and group 2 with mandibular asymmetry (menton deviation, >4 mm; n = 9). Landmarks were designated on the reconstructed three-dimensional models. Correlations and proportions of changes of the soft tissue to hard tissue were calculated. There were significant correlations of ΔB' to ΔB and ΔPog' to ΔPog in both groups on the horizontal axis (P < 0.05), and their proportions were 0.53 and 0.67 in group 1 and 0.77 and 0.88 in group 2, respectively. There were significant correlations of ΔB' to ΔB, ΔPog' to ΔPog, and ΔMe' to ΔMe on the sagittal axis in both groups (P < 0.05), and their proportions were 0.94, 0.84, and 0.96 in group 1 and 0.95, 0.91, and 1.03 in group 2, respectively. There were significant correlations of the three-dimensional distances between ΔB' to ΔB, ΔPog' to ΔPog, and ΔMe' to ΔMe in both groups (P < 0.05), and their proportions were 0.92, 0.79, and 0.95 in group 1 and 0.92, 0.88, and 0.97 in group 2, respectively. However, there were no significant correlations between changes in soft and hard tissues on the vertical axis in both groups (P > 0.05). In class III orthognathic patients with mandibular asymmetry, the proportions of ΔB' to ΔB, ΔPog' to ΔPog, and ΔMe' to ΔMe on the horizontal and sagittal axes and the three-dimensional distances were different from patients with no mandibular asymmetry.

Modification of intraoral vertical ramus osteotomy

s g ntraoral vertical ramus osteotomy (IVRO) has a low risk f injury to the inferior alveolar nerve during mandibular etback. It is also efficacious for disorders of the temporoandibular joint, 1 and results in predictable postoperative tability.2 However, it can result in lateral flaring of proxmal segments or inadequate setback resulting from bony nterference. These complications can be managed with corooidotomy, though it prolongs recovery. In this report we ntroduce a modification of IVRO to minimise interference nd lateral flaring. A mucosal incision 4 cm long is made over the external blique ridge, and broad dissection over the lateral ramus. pair of Bauer retractors is placed in the sigmoid and ntegonial notches to visualise the antelingular prominence, nd a conventional double slide osteotomy done. A round scillating saw is used to make the angle at the antelinular prominence easier. The saw blade is then directed nterosuperiorly (Fig. 1a) towards the sigmoid notch, and wedge-shaped osteotomy made. Bleeding from the internal maxillary artery can be preented with the Bauer retractors and by avoiding deep lacement of the blade during the osteotomy. The wedge ragment from the YVRO is removed before dissection of the

Postoperative stability for surgery-first approach using intraoral vertical ramus osteotomy: 12 month follow-up

The aim of this study was to evaluate the postoperative stability of the surgery-first approach using intraoral vertical ramus osteotomy (IVRO). We retrospectively studied a sample derived from the patients who were treated by the surgery-first approach using a LeFort I osteotomy and IVRO for correction of class III dentofacial deformity from 2008 to 2012. Lateral cephalograms taken preoperatively and 2 days, 6 months, and 12 months postoperatively were traced, and the skeletal and dental variables at different time points were analysed. The study sample comprised 37 subjects, mean (SD) age 23 (4) years. The mean (SD) total duration of treatment including postoperative orthodontics was 14 (6) months, and surgical movement of the maxillary A point was 0.75 (1.3)mm anteriorly, and 0.21 (1.79)mm superiorly. The surgical change in the position of the maxillary first molar was 1.01 (1.57)mm superiorly. The mean (SD) movement of mandible was 11.15 (5.4)mm posteriorly at pogonion and 1.02 (1.79)mm inferiorly at menton. There were no significant change in maxillary skeletal variables during the first year postoperative period. The surgical relapse of mandible at pogonion was 0.63 (2.31) mm anteriorly (p=0.01), however, the relapse in superior direction at menton was 2.86 (1.39) mm with statistical significance (p=0.01). The total duration of orthodontic treatment with surgery-first was roughly 5 months shorter than conventional preoperative and postoperative orthodontic treatment. The surgery-first approach using IVRO is effective and predictable, and shortens the overall duration of treatment. Anterior relapse of the mandible was less than 1mm, and increased superior relapse can be compensated for with appropriate preoperative planning to provide a reliable outcome. This study was limited to 12 months’ follow-up, and a long term follow-up study is indicated.

Two-year follow-up of changes in bite force and occlusal contact area after intraoral vertical ramus osteotomy with and without Le Fort I osteotomy

This study was performed to examine the longitudinal changes in bite force and occlusal contact area after mandibular setback surgery via intraoral vertical ramus osteotomy (IVRO). Patients with mandibular prognathism who underwent IVRO (surgical group: 39 men and 39 women) were compared with subjects with class I skeletal and dental relationships (control group; 32 men and 35 women). The surgical group was divided into two subgroups: 1-jaw surgery (n=30) and 2-jaw surgery (n=48). Bite force and contact area were measured in maximum intercuspation with the Dental Prescale System before treatment, within 1 month before surgery, and at 1, 3, 6, 9, 12, and 24 months postsurgery. A linear mixed model was used to investigate the time-dependent changes and associated factors. Bite force and contact area decreased during presurgical orthodontic treatment, were minimal at 1 month postsurgery, and increased gradually thereafter. The 1-jaw and 2-jaw subgroups showed no significant differences in bite force. The time-dependent changes in bite force were significantly different according to the contact area (P<0.05). The results of this study suggest that bite force and occlusal contact area gradually increase throughout the postsurgical evaluation period. Increasing the occlusal contact area may be essential for improving bite force after surgery.

Treatment of Temporomandibular Joint Ankylosis by Posterior Border of Mandibular Ramus Osteotomy

Temporomandibular joint (TMJ) ankylosis (TMJA) is an anatomic and functional alteration of the TMJ surfaces, caused by the fusion of these surfaces by either bone or fibrous tissue. Several techniques are used for the treatment of TMJA. The following case report describes a 5-year-old boy who was diagnosed with TMJA. The treatment of choice is reconstruction of the condyle by sliding the posterior border of the mandibular ramus. Temporomandibular joint ankylosis treatment with vertical ramus osteotomy and mandibular posterior border repositioning offers minimizing the reduction in height or shortening of the mandibular posterior border. The postoperative period requires a multidisciplinary approach with an aggressive physiotherapy.

One-Stage Treatment to Condylar Osteochondroma Combined With Secondary Jaw Bone Deformities by Sliding Vertical Ramus Osteotomy and Mandibular Contouring

Osteochondroma of the mandibular condyle could cause secondary facial asymmetry; besides, it could affect the function of the temporomandibular joint (TMJ) and occlusion. Conventional treatments include total condylectomy or local resection of the lesion and condylar reconstruction. But it cannot effectively ameliorate the facial asymmetry. Thus, this article presents the application of combination surgeries including condylectomy, sliding vertical ramus osteotomy, and mandibular contouring in the treatments of this kind of disease. From 2007 to 2012, 12 patients with osteochondroma of the mandibular condyle were included. All of them accepted condylectomy, sliding vertical ramus osteotomy, and mandibular contouring at 1 stage. Mandibular contouring included mandibular inferior border ostectomy, mandibular outer cortex ostectomy, and horizontal osteotomy genioplasty according to the characters of jaw deformity. In addition, maximal mouth opening, pain in the TMJ, and numbness of the lower lip were recorded preoperatively and postoperatively to evaluate the therapeutic effects. All of patients obtained satisfactory results; TMJ dysfunction, facial asymmetry, and abnormal occlusion were improved greatly. No patients developed recurrence of the tumor during the follow-up period. In conclusion, after condylectomy, sliding vertical ramus osteotomy and mandibular contouring were operated at 1 stage, which effectively ameliorated the condylar osteochondroma patient's facial asymmetry and abnormal occlusion and achieved good therapeutic effects.

A follow-up study on extracorporeal fixation of condylar fractures using vertical ramus osteotomy.

ObjectivesThe aim of this study is to report the results of extracorporeal fixation in patients with mandibular condylar fractures and compare them with the clinical results of conservative treatment.Materials and MethodsThe medical records of 92 patients (73 male [M] : 19 female [F], age 13-69 years, mean 33.1 years) treated for condylar fractures at the Department of Oral and Maxillofacial Surgery in Sun Dental Hospital (Daejeon, Korea) from 2007 to 2012 were reviewed. Patients were divided into three groups: group A (23 patients; M : F=18 : 5, age 21-69 years, mean 32.6 years), treated with extracorporeal fixation; group B (30 patients; M : F=24 : 6, age 16-57 years, mean 21.1 years), treated by conventional open reduction; and group C (39 patients; M : F=31 : 8, age 16-63 years, mean 34.4 years), treated with the conservative method ('closed' reduction). Clinical and radiographic findings were evaluated and analyzed statistically.ResultsOccurrence of postoperative condylar resorption correlated with certain locations and types of fracture. In this study, patients in group A (treated with extracorporeal fixation) did not demonstrate significant postoperative complications such as malocclusion, mandibular hypomobility, temporomandibular disorder, or complete resorption of condyle fragments.ConclusionIn superiorly located mandibular condyle fractures, exact reconstruction of condylar structure with the conventional open reduction technique can be difficult due to the limited surgical and visual fields. In such cases, extracorporeal fixation of the condyle using vertical ramus osteotomy may be a better choice of treatment because it results in anatomically accurate reconstruction and low risk of complications.

周術期のD2受容体阻害薬投与が誘因となり急性ジストニアを発症したと考えられた顎変形症患者の1例

Postoperative nausea and vomiting (PONV) is a typical complication of orthognathic surgery. D2 receptor antagonist is commonly used as an anti-emetic drug, but it also has a potential risk of inducing extrapyramidal reaction. We report a case of acute dystonia probably caused by intravenous infusion of D2 receptor antagonist in a patient with jaw deformity during the perioperative period. The patient was a 21-year-old man who was diagnosed as having maxillary protrusion. He underwent intraoral vertical ramus osteotomy under general anesthesia which was uneventfully performed using sevoflurane and remifentanyl. Immediately following the surgery, droperidol was administered in order to prevent PONV. After emergence, he complained of nausea and D2 receptor antagonist was administered, but had no effect. On the first postoperative day, he showed acute dystonia with nystagmus and opisthotonus. Diazepam was administered and his symptom disappeared. We should pay attention to acute dystonia when using D2 receptor antagonist and need to develop effective management methods for preventing PONV.

Unilateral intraoral vertical ramus osteotomy based on preoperative three-dimensional simulation surgery in a patient with facial asymmetry

Preoperative surgical simulation in orthognathic surgery has progressed in recent years; the movement of the mandible can be anticipated through three-dimensional (3D) simulation surgery before the actual procedure. In this case report, the mandible was moved to the intended postoperative occlusion through preoperative surgical 3D simulation. Right-side condylar movement change was very slight in the surgical simulation, suggesting the possibility of mandibular surgery that included only left-side ramal osteotomy. This case report describes a patient with a mild asymmetric facial profile in which the mandibular menton had been deviated to the right and the lips canted down to the left. Before surgery, three-dimensional surgical simulation was used to evaluate and confirm a position for the condyle as well as the symmetrical postoperative state of the face. Facial asymmetry was resolved with minimal surgical treatment through unilateral intraoral vertical ramus osteotomy on the left side of the mandible. It would be a valuable complement for the reduction of the surgical treatment if one could decide with good predictability when an isolated intraoral vertical ramus osteotomy can be done without a compensatory osteotomy on the contralateral side.

Comparative analysis of the amount of postoperative drainage after intraoral vertical ramus osteotomy and sagittal split ramus osteotomy.

ObjectivesThe purpose of this retrospective study was to compare the amount of postoperative drainage via closed suction drainage system after intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO).Materials and MethodsWe planned a retrospective cohort study of 40 patients selected from a larger group who underwent orthognathic surgery from 2007 to 2013. Mean age (range) was 23.95 (16 to 35) years. Patients who underwent bilateral IVRO or SSRO were categorized into group I or group II, respectively, and each group consisted of 20 patients. Closed suction drainage system was inserted in mandibular osteotomy sites to decrease swelling and dead space, and records of drainage amount were collected. The data were compared and analyzed with independent t-test.ResultsThe closed suction drainage system was removed at 32 hours postoperatively, and the amount of drainage was recorded every 8 hours. In group I, the mean amount of drainage was 79.42 mL in total, with 31.20 mL, 19.90 mL, 13.90 mL, 9.47 mL, and 4.95 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. In group II, the mean total amount of drainage was 90.11 mL, with 30.25 mL, 25.75 mL, 19.70 mL, 8.50 mL, and 5.91 mL measured at 0, 8, 16, 24, and 32 hours postoperatively, respectively. Total amount of drainage from group I was less than group II, but there was no statistically significant difference between the two groups (P=0.338). There was a significant difference in drainage between group I and group II only at 16 hours postoperatively (P=0.029).ConclusionIVRO and SSRO have different osteotomy design and different extent of medullary exposure; however, our results reveal that there is no remarkable difference in postoperative drainage of blood and exudate.

Risk of Maxillary Artery Injury During an Intraoral Vertical Ramus Osteotomy in Japanese Patients is High—Is It Enough Just to Avoid Damaging the Inferior Alveolar Nerve?

Since managing a case in which the maxillary artery was injured during intraoral vertical ramus osteotomy (IVRO) with intraoperative transcatheter arterial embolization, we have conducted preoperative vascular computed tomography (CT) evaluations of the maxillary artery course in patients scheduled to undergo mandibular bone osteotomy. The aim of the present study was to describe the anatomy of the maxillary artery in the infratemporal artery in Japanese patients. The study design was a prospective case series. The study sample included all patients who had undergone IVRO from October 2009 to December 2012. We evaluated the positional relationship between the maxillary artery and the mandible using CT vascular imaging before surgery. The primary outcome variable was the requirement for subperiosteal dissection on the medial surface of the mandible from the perspective of the intersection of the route of the maxillary artery with the IVRO osteotomy line. A total of 156 sides from 78 patients who had undergone mandibular bone osteotomy were included in the present study. The maxillary artery course was positioned directly below the mandibular notch in approximately one half of the cases, necessitating subperiosteal dissection on the medial surface of the mandible. IVRO is a common surgical procedure that can be safely and easily conducted in conjunction with endoscopy. However, improved maxillary artery damage prevention methods are recommended, such as subperiosteal dissection on the medial surface of the mandible and filling the medial surface of the mandibular ramus with gauze.

Changes in the lip-line in asymmetrical cases treated with isolated mandibular surgery

The aim of this study was to investigate changes in the lip-line in asymmetrical cases treated with mandibular osteotomy alone. Retrospective study. Hiroshima University Institute of Biomedical & Health Sciences, Hiroshima, Japan The subjects in this study consisted of 30 patients with an altered lip-line inclination who underwent isolated mandibular osteotomy (bilateral or unilateral sagittal split ramus osteotomy or intraoral vertical ramus osteotomy) as part of their surgical correction. Frontal cephalograms and facial photographs, taken at the first examination and after treatment, were used to measure changes in the inclination of the lip-line and cant of the occlusal plane, as well as the lateral deviations of hard and soft tissue Menton. Inclination of the lip-line after active treatment was significantly improved compared with that before treatment. Menton on the hard and soft tissues after active treatment also experienced a significant improvement compared with its position at first examination. One-jaw mandibular osteotomy is able to improve the inclination of the lip-line even in the presence of an occlusal cant. The inclination of the lip-line is corrected in association with sufficient lateral movements of Menton on the mandible.