Skeletal stability after surgical correction of mandibular prognathism by vertical ramus osteotomy

The purpose of the study was to assess skeletal stability following combined surgical-orthodontic management of 52 adults with severe mandibular prognathism. Lateral cephalograms taken 1 week before surgery, within 1 week post-surgery and approximately 1 year after operation were studied by means of eight variables and a constructive stable reproducible reference system. The surgical procedure of choice was a bilateral vertical ramus osteotomy through an extra-oral approach. In all cases the condyles were left passively in the articular fossa and no attempt at their active repositioning was made. The patients were randomly allocated to an osteosynthesis or non-osteosynthesis group with regard to intramandibular fixation. Intermaxillary fixation lasted 6 weeks and an interocclusal wafer was used in all cases during this period. The findings of this study showed that during the post-operative period there was a trend for posterior rotation of the mandibular corpus (P less than 0.001). This pattern was also characterized by an increase (P less than 0.001) of the lower anterior face height and an improvement of the angle of convexity (P less than 0.001). These changes occurring in a direction so that the dentoskeletal profile became less concave, did not tend to reverse the goal of operation and cannot be considered as detrimental. No significant differences (P greater than 0.05) were found between the groups without and with osteosynthesis.