Severe skeletal Class III malocclusion treated with 2-stage orthognathic surgery with a mandibular step osteotomy

To reduce a large amount of mandibular setback and to prevent pharyngeal airway space narrowing when correcting a severe anteroposterior skeletal discrepancy, a mandibular step osteotomy is often combined with 2-stage orthognathic surgery. This case report describes a successful 2-stage orthognathic treatment combined with a mandibular step osteotomy. A 20-year-old man had severe mandibular protrusion, facial asymmetry, and macroglossia. Phase 1 surgery included the mandibular step osteotomy and a partial glossectomy; then we performed phase 2 surgery with a 2-piece LeFort I segmental osteotomy and a bilateral intraoral vertical ramus osteotomy to correct the patient's mandibular protrusion and facial asymmetry. The total treatment period was 30 months, and the final result was improvement of the patient's facial appearance.