Surgical Class III treatment: long-term stability and patient perceptions of treatment outcome

To evaluate long-term changes after surgical correction of skeletal Class III deformity, postoperative cephalometric radiographs at 1 year and 2 or more years postsurgery were digitized for 92 patients who had received either a bilateral sagittal split osteotomy for mandibular setback, Le Fort I maxillary advancement, or a combination of the two procedures. Patients' perceptions of treatment were determined by four self-administered questionnaires: satisfaction, postsurgical perception of occlusion and function, problems with facial sensation, and postsurgical perceptions. From 1 year to longest follow-up, there were almost no mean changes in landmark positions for the maxillary advancement group and minimal mean changes in the mandibular setback and two-jaw groups. In all three groups, more than 90% of the patients showed no clinically significant long-term changes, which suggests that long-term changes are less likely after Class III than Class II treatment. At long-term recall, 89% of the patients expressed satisfaction with their treatment and would recommend it to others, 74% reported improved social interaction, and 63% said their appearance changed as they expected. The predominant problems reported were altered facial sensation for 67% of the patients and surprise at the length of recovery for 52%.