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Updated: Jun 14, 2026
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Quantitative Assessment Protocol for Facial Soft Tissue Volumetric Changes with Stereophotogrammetry
Published on: December 9, 2025
Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement: a systematic review
Christof Urs Joss1, Isabella Maria Joss-Vassalli, Stavros Kiliaridis
1Department of Orthodontics and Oral Biology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. christofjoss@hotmail.com
Summary
This systematic review found that soft tissue changes after mandibular advancement surgery (Bilateral Sagittal Split Advancement Osteotomy) show high variability. More high-quality prospective studies are needed to establish evidence-based conclusions on soft tissue outcomes.
Area of Science:
- Oral and Maxillofacial Surgery
- Orthodontics
- Plastic Surgery
Background:
- Mandibular advancement surgery, specifically Bilateral Sagittal Split Advancement Osteotomy (BSSO), is a common procedure for correcting skeletal discrepancies.
- Understanding soft tissue changes following BSSO is crucial for predicting aesthetic outcomes.
- The soft tissue to hard tissue ratio is a key metric for evaluating surgical success.
Purpose of the Study:
- To systematically review and evaluate the soft tissue to hard tissue ratio after BSSO using rigid internal fixation (RIF) or wire fixation (WF).
Main Methods:
- A comprehensive literature search was conducted across multiple databases (PubMed, Medline, CINAHL, Web of Science, Cochrane Library, Google Scholar Beta).
- Twelve studies were included from an initial 711 articles, comprising 3 prospective and 9 retrospective studies.
- Postoperative follow-up periods varied, ranging from 3 months to 12.7 years for RIF and 6 months to 5 years for WF.
Main Results:
- The lower lip to lower incisor ratio was consistently 50% for both RIF and WF in the short and long term.
- No significant difference was observed in the mentolabial fold to Point B or soft tissue pogonion to pogonion ratios (1:1) between fixation methods.
- Long-term soft tissue pogonion to pogonion ratios with RIF tended to exceed 1:1, and upper lip changes showed high variability with a general tendency towards retrusion.
Conclusions:
- Evidence-based conclusions regarding soft tissue changes after BSSO remain elusive due to limitations in study design, reliance on retrospective data, and lack of standardized outcome measures.
- High variability in soft tissue response necessitates further investigation.
- Well-designed prospective studies with adequate sample sizes, excluding patients with concurrent surgeries like genioplasty or maxillary osteotomy, are essential for robust findings.
