Orthognathic surgery versus orthodontic camouflage in the treatment of mandibular deficiency

Surgical correction of Class II malocclusions, when associated with mandibular deficiency, often has improved results with combined orthodontic and surgical correction compared with orthodontic treatment alone. Strong consideration of surgical correction of mandibular deficiency should be based on the following questions: 1) Do the patient's goals for treatment place a high priority on improvement in facial esthetics? As a corollary, even patients who are not particularly concerned with facial esthetics, but who may have a worsening in facial appearance as a result of orthodontic camouflage, should be considered for surgical correction. This may include patients with lack of upper lip support, an obtuse nasolabial angle, a large nose, and a long lower face height, all of which may become more apparent as a result of orthodontic camouflage treatment. 2) Are the orthodontic movements required in excess of the envelope of discrepancy so that adequate orthodontic correction may not be achieved? 3) Could orthodontic-surgical treatment result in a significant decrease in treatment time? An example would be when surgical treatment in combination with orthodontics could be accomplished without extraction, whereas orthodontic treatment alone would require extraction and space closure. 4) Is there adequate patient compliance? Would orthodontic treatment alone be as ineffective without adequate patient cooperation? 5) Are the risks of surgery within acceptable levels? Are the benefits of surgical treatment, as previously described, obvious?