Mandibular advancement surgery in high-angle and low-angle class II patients: different long-term skeletal responses

The objective of this cephalometric study was to compare skeletal stability and the time course of postoperative changes in high-angle and low-angle Class II patients after mandibular advancement surgery. The subjects were 61 consecutive mandibular retrognathism patients whose treatment included bilateral sagittal split osteotomy and rigid fixation. The patients were divided according to the preoperative mandibular plane angle; the 20 patients with the lowest mandibular plane angle (20.8 degrees +/- 4.9 degrees ) constituted the low-angle group, while the 20 cases with the highest mandibular plane angle (43.0 degrees +/- 4.0 degrees ) represented the high-angle group. Lateral cephalograms were taken on 6 occasions: immediately before surgery, immediately after surgery, 2 and 6 months after surgery, and 1 and 3 years after surgery. Results demonstrated that the high-angle and low-angle groups had different patterns of surgical and postoperative changes. High-angle patients were associated with both a higher frequency and a greater magnitude of horizontal relapse. While 95% of the total relapse took place during the first 2 months after surgery in the low-angle group, high-angle patients demonstrated a more continuous relapse pattern, with a significant proportion (38%) occurring late in the follow-up period. Possible reasons for the different postsurgical response are discussed.