Skeletal deformities and surgical procedures in orthognathic surgery patients: a 10-Year retrospective analysis of 1095 cases

Abstract

Background Orthognathic surgery is a well-established method for correcting skeletal dentofacial deformities. Despite its widespread application, large-scale data describing deformity prevalence and the distribution of surgical approaches remain limited. This study aimed to determine the prevalence and patterns of skeletal deformities and orthognathic surgical procedures in patients who underwent orthognathic surgery. Methods In this retrospective study, the radiographic records of 1095 patients (663 females, 432 males; aged 16-65 years; mean age: 23.07 +/- 5.6 years) treated between 2014 and 2024 were analyzed. Sagittal deformities were classified using the ANB angle as Class I (0 degrees <= ANB <= 4 degrees), Class II (ANB > 4 degrees), and Class III (ANB < 0 degrees), supported by Wits appraisal, overjet, and soft tissue profile evaluation. Maxillary transverse deficiency was diagnosed clinically or radiographically, with surgically assisted rapid palatal expansion (SARPE) recorded as the treatment modality. Surgical procedures included Le Fort I, bilateral sagittal split osteotomy (BSSO), segmental osteotomy, distraction osteogenesis, condylectomy, and genioplasty. Patients were further classified by sequencing (maxilla-first vs. mandible-first) and protocol (surgery-first vs. orthodontics-first). Results Class III deformity was most frequent (71.3%), followed by Class II (17.6%) and Class I (2.1%). Maxillary transverse deficiency was observed in 8.9% of patients (34.7% Class I, 29.6% Class II, 35.7% Class III), for whom surgically assisted rapid palatal expansion (SARPE) was performed as the treatment modality. Asymmetry was found in 10.8% of patients (1.6% with condylectomy), anterior open bite in 11.5%, vertical maxillary excess in 1.3%, and cleft lip/palate in 1.9%. Genioplasty was performed in 7.9%. Rarely, segmental osteotomy (0.7%) or mandibular distraction (0.3%) was applied. The most frequent procedure was bimaxillary surgery involving Le Fort I and BSSO (69.1%). Maxilla-first sequencing was preferred in 91.4% of bimaxillary cases, while 1.2% underwent surgery-first treatment. Conclusion In this large cohort, the maxilla-first approach was predominantly preferred in bimaxillary surgery, with most patients being young adult females with skeletal Class III deformities. Maxillary transverse deficiency (8.9%) was managed with SARPE, while the rarity of surgery-first protocols reflected case complexity. These findings underscore the importance of individualized planning, patient counseling, and the integration of digital technologies to optimize outcomes in diverse dentofacial deformities.