Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41. Long- ace synd ome
e435
Jou nal sec ion: O al Su ge y
Publica ion Types: Resea ch
Long- e m s abili y o su gical-o hodon ic co ec ion
o class III malocclusions wi h long- ace synd ome
Da id Gallego-Rome o 1, José-Ma ía Llamas-Ca e a 1, Daniel To es-Laga es 2, Vanessa Pa edes 3, Edua do
Espina 1, Edua do Gue a a 4, José-Luis Gu ié ez-Pé ez 5
1 Associa e P o esso – Uni e si y o Se ille
2 Assis an P o esso o O al Su ge y – Uni e si y o Se ille
3 Associa e P o esso – Uni e si y o Valence
4 Mas e in O hodon ics – Uni e si y o Se ille
5 Head P o esso o O al Su ge y – Uni e si y o Se ille
Co espondence:
Facul ad de Odon ología
Uni e sidad de Se illa
C/ A icena s/n
41009 Se illa, Spain
daniel [email protected]
Recei ed: 31-01-2011
Accep ed: 03-08-2011
Abs ac
Objec i es: In he i s place, o e alua e skele al changes o he maxilla and mandible induced by su gical-o h-
odon ic co ec ion o malocclusions class III wi h long- ace synd ome and secondly, o analyze he s abili y o
hese skele al changes in he long e m (mo e han 6 yea s).
Design o S udy: A e ospec i e, unicen ic and longi udinal s udy o 19 pa ien s who had unde gone su gical and
o hodon ic he apy o class III skele al malocclusion wi h long- ace synd ome was unde aken. A cephalome ic
analysis based on 8 angle measu emen s, and s a is ical analyses a h ee di e en poin s in ime (be o e o hodon-
ic ea men , a e o hogna hic su ge y and a e a e en ion pe iod o a leas 6 yea s) we e ca ied ou .
Resul s: The changes p oduced ollowing su ge y show ha , wi h he excep ion o he maxilla y plane and he
acial axis, all o he a iables p esen ed changes o g ea s a is ical di e ence.
Conclusions: Skele al changes a e o hodon ic-su gical co ec ion p esen maxilla y ad ance, mandibula e-
g ession and mandibula an e o o a ion. The angles ha ep esen he mandibula e ical posi ion ( amus angle,
goniac angle and mandibula plane angle) showed s a is ically signi ican elapses and no s abili y in con as o
he acial axis.
Key wo ds: Long e m esul s, s abili y, elapse, o hogna hic su ge y, class III, long ace.
Gallego-Rome o D, Llamas-Ca e a JM, To es-Laga es D, Pa edes V,
Espina E, Gue a a E, Gu ié ez-Pé ez JL. Long- e m s abili y o su gi-. Long- e m s abili y o su gi-
cal-o hodon ic co ec ion o class III malocclusions wi h long- ace syn-
d ome.Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41.
h p://www.medicinao al.com/medo al ee01/ 17i3/medo al 17i3p435.pd
A icle Numbe : 17647 h p://www.medicinao al.com/
© Medicina O al S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946
eMail: [email p o ec ed]
Indexed in:
Science Ci a ion Index Expanded
Jou nal Ci a ion Repo s
Index Medicus, MEDLINE, PubMed
Scopus, Embase and Emca e
Indice Médico Español
doi:10.4317/medo al.17647
h p://dx.doi.o g/doi:10.4317/medo al.17647
Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41. Long- ace synd ome
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In oduc ion
An o hogna hic su ge y ea men ep esen s a sig-
ni ican e o o bo h he pa ien and he p o essional
and, in his sense, bo h aspi e o see ha e o ewa ded
wi h a esul no only success ul, bu also easonably
s able o e ime (1).
Facial synd omes ela ed o excessi e e ical dimen-
sion, such as Class III malocclusion wi h long- ace syn-
d ome, can be ea ed by means o su gical manipula ion
o he jaws, so imp o ing he skele al-den al ela ion-
ship and esul ing in a mo e aes he ic p opo ion (1).
The occu ence o elapse has been widely s udied o
de e mine he ac o s a ec ing i ; hese include en-
i onmen al ac o s such as mas ica o y unc ion, a
p ope den al in e digi a ion, bone healing, condyla
posi ioning in he glenoid ca i y, neu omuscula ad-
ap a ion, magni ude o su gical change, du a ion and
me hod o maxillomandibula ixa ion, eso p ion and
condyla g ow h, ongue p essu e, pa ien age, su geon
expe ience o he use o bone g a s in maxilla y b eak-
h oughs. Sagi al p oblems a e mo e s able a e ea -
men , whe eas e ical p oblems, which ou s udy is
conce ned wi h, a e less so (2-10).
Al hough many s udies ha e shown s abili y o esul s
ollowing o hogna hic su ge y e sus o hodon ic ea -
men (11,12) ew ha e epo ed such s abili y in mandib-
ula an e o o a ion (13). Shendel and Epke (13) epo -
ed poo skele al s abili y in mandibula an e o o a ion;
hey ela ed his ac o he inc ease in pos e io acial
heigh , associa ed wi h an inc ease in he p e igo-mase-
e ic muscula u e leng h. P o i e al. (14) ound ha
he su gical dec ease o an e io acial heigh , caused
by mandibula an e o o a ion in he an e io open bi e
co ec ion, could comp omise esul ing s abili y. Thei
esul s showed, ha , in pa ien s wi h maxilla y e ical
excess and an e o-pos e io mandibula de iciency, he
e ical eposi ioning o he maxilla and he mandibula
ad ance we e mo e s able wi h a clinical success a e o
60%. On he o he hand, Chemello e al. (15) did epo
s able esul s in an e o o a ions, concluding ha he
success o hese cases can be achie able h ough co -
ec o hodon ic ea men , p ope su gical echnique
and he p esence o heal hy TMJs.
Despi e he ac ha he numbe o skele al Class III pa-
ien s wi h long- ace synd ome who ha e unde gone su -
ge y has inc eased ema kably (16,17), i is su p isingly di -
icul o ind da a and epo s on he long- e m s abili y o
his p ocedu e wi h ollow up esul s o mo e han 3 yea s
a e he apy has ended. This is, he e o e, he eason o
unde aking his s udy. Fu he mo e, he long e m esul s
o su gical p ocedu es a e no well documen ed o su -
icien ly homogeneous samples o pa ien s wi h inc eased
lowe e ical acial heigh and skele al Class III.
The objec i es o his s udy we e, in he i s place, o
e alua e skele al changes o he maxilla and mandible
induced by su gical-o hodon ic co ec ion o malocclu-
sions class III wi h long- ace synd ome, and secondly,
o analyze s abili y o hese skele al changes a e a long
e en ion pe iod (mo e han 6 yea s).
Ma e ial and Me hods
This s udy is a e ospec i e, unicen ic, longi udi-
nal clinical s udy o skele al Class III pa ien s wi h
long- ace synd ome. The s udy popula ion was de-
ined as long ace synd ome based on cephalome ic
alues. All pa ien s we e cephalome ically and a-
cially dolicho acial (p opo ions o acial hi ds and
mandibula plane se e ely o a ed clockwise). All
he pa ien s had an e io open bi e be o e ea men .
The aims o he ea men we e bo h, o sho en ace
heigh and o close open bi e. All pa ien s had p e i-
ously unde gone p e-su gical o hodon ic ea men and
su gical co ec ion a e wa ds h ough bimaxilla y su -
ge y. All cases we e ope a ed on by wo su geons who
ope a e join ly on all hei pa ien s. In e maxilla y ixa-
ion was used in he su ge ies.
Included in ou sample we e bo h male and emale pa-
ien s who had ob ained good esul s in acial and oc-
clusal pa ame e s a e he ea men and whose clinical
eco ds we e alid and a ailable o conduc ing a long-
e m ollow up o a leas 6 yea s ollowing he end o
he su gical-o hodon ic ea men . A u he inclusion
c i e ion was he p esence o s abili y in e ical and
sagi al den occlusal landma ks a e he same pe iod
o ime, no mo e han 2 mm o elapse in o e bi e o
o e je being conside ed as s able. We elimina ed he
cases wi h li le den al s abili y, as he aim was o s udy
whe he skele al s abili y had accompanied den al s a-
bili y. Those pa ien s who did no ul ill he inclusion
c i e ia and hose whose adiog aphic eco ds p esen ed
poo quali y o he e ogeneous magni ica ions we e ex-
cluded om he s udy.
19 pa ien s pa icipa ed in his s udy; 14 emale (73.7%)
and 5 male (26.3%). The cephalome ic analysis applied
in he p esen s udy was a a ia ion o he me hod de-
eloped by Bjo k and Skielle which was modi ied by
Nielsen. A o al o 8 angle measu emen s we e used a
h ee di e en poin s in ime (be o e o hodon ic ea -
men , a e o hogna hic su ge y and a e a e en ion pe-
iod o a leas 6 yea s). All images we e eco ded by he
same ope a o and machine (O oceph 50®, Siemens).
All selec ed adiog aphs ul ill he ollowing quali y
equi emen s: eco ded in he maximum in e cuspal;
co ec isualiza ion o equi ed bone s uc u es; no
magni ica ion p oblems and, in o de o ob ain a alid
supe posi ion, he cephalos a e was used co ec ly o
a oid duplica ed images esul ing om head o a ion.
The cephalome ic landma ks shown in able 1 we e
iden i ied in he la e al cephalog ams and angle alues
we e de e mined (Fig. 1).
Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41. Long- ace synd ome
e437
Table 1. Cephalome ic landma ks and angula alues.
Fig. 1. Angle alues used in ou s udy.
An e io skull base leng h was conside ed as he plane
o e e ence, ep esen ed by he Sella-Nasion line (SN).
The ANB angle was p e e ed ins ead o ANPg, as some
o he pa ien s had unde gone genioplas y p ocedu es.
The da a s udied we e app op ia e as hey allowed us o
assess he posi ional changes in he maxilla, bo h sagi -
ally (SNA) and e ically (maxilla y plane), in he man-
dible, bo h sagi ally (SNB) and e ically (mandibula
plane, mandibula angle, amus angle and acial axis)
and he in e maxilla y sagi al ela ionship (angle ANB).
These measu emen s we e ca ied ou a h ee di e en
s ages o he s udy: The 1s se o measu emen s was e-
co ded p io o o hodon ic ea men , he 2nd a e he
end o su gical-o hodon ic ea men and he 3 d a e
a e en ion pe iod o a leas 6 yea s. Figu e 2 shows an
example o hese measu emen s aken on one pa ien a
he h ee di e en s ages o he s udy. The mean ime
pe iod elapsing be ween he 1s and 2nd measu emen
was 2.2 yea s ( ange: 1-3.5 yea s), be ween he 2nd and
3 d 7.6 yea s ( ange: 6-10 yea s) and inally, be ween he
1s and he 3 d measu emen 9.8 yea s ( ange: 8-12 yea s).
All pa ien s we e ea ed wi h he same su gical and
ixa ion echnique. Good in e incisal con ac was ob-
ained. Two su geons wo king oge he ope a ed on all
cases. In o de o alida e he measu emen p ocedu e,
we ca ied ou e o assessmen on en andomly selec -
ed acings, which we e measu ed once again. S uden ’s
- es and co ela ion did no show signi ican di e -
ences (p > 0.05 and > 0.95). We also ca ied ou non-
pa ame ic Wilcoxon Signed Rank es o de e mine he
signi icance o he changes obse ed when compa ing
he h ee s ages o measu emen s. A p alue o < 0.05
was conside ed s a is ically signi ican . All s a is ics
we e analyzed using S a iew 4.5 o Macin osh.

CEPHALOMETRICLANDMARKSANGULARVALUES 
Sella(S)SNAangle(SNA) 
SAGITTALRELATIONSHIP
3ANGLES

Nasion(N)SNBangle(SNB)
Poin A(A)ANBangle(ANB)
Poin B(B)Maxilla yplaneinclina ion
(SN/ANSͲPNS)


VERTICALRELATIONSHIP
5ANGLES
GonionPoin (Go)Mandibula planeinclina ion
(SN/GoGn)
Gna ionPoin (Gn)Gonialangle(GoA /GoGn)
A icula Poin (A )Mandibula  amusplaneinclina ion
(GoA /GoGn)
An e io nasalpoin (ANS)FacialAxis(SN/Gn)
Pos e io nasalpoin (PNS)

Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41. Long- ace synd ome
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Resul s
The age di e ences be ween males and emales we e s a is i-
cally signi ican a he 1s and 2nd measu emen s (Table 2).
The da a ob ained a e shown in able 3. F om he 1s
o he 2nd, we obse ed a ia ions esul ing om he
ea men , while changes obse ed om he 2nd o he
3 d e lec he long- e m esul s o he a iables unde
s udy. Finally, he changes obse ed be ween he 1s
and he 3 d ep esen he magni ude o o al changes,
whe he elapse has aken place o no .
The s a is ical signi icance o he di e ences and/o
changes shown by he da a is p esen ed in able 4. S a-
is ically signi ican p alues less han 0.001 a e ma ked
as ***, be ween 0.001 and < 0.01 as **, and be ween
0.01 and < 0.05 as *. A “p” alue highe han 0.05 is no
s a is ically signi ican (NS).
Fig. 2. Cephalome ic acings a he h ee obse a ions.
Ou pa ien s had a e uded sagi al posi ion o he uppe
jaw wi h espec o he c anial base (SNA 76.42º ± 2.68º),
while he angle SNB was wi hin he no mal ange (79.24º
± 3.66º). The maxilla y plane (12.45° ± 3.03º) showed a
sligh an e io maxilla y dec ease while he mandibula
plane inc eased. The mandibula angle (141.89° ± 3.30º)
indica es he e icali y o he mandibula amus while
he educed amus plane (84.76° ± 1.61º) is cha ac e is ic
o an excess o e ical mandibula g ow h and occu s
mainly due o an opening o he mandibula body a he
mandibula angle. Finally, he acial axis (70.29° ± 3.63º)
showed a g ea e opening han no mal.
In he 2nd measu emen s, he angle SNA app oached
alues close o no mal (p<0.0001) al hough he SNB
was 77.61° ± 3.77º (p <0.0001). Al hough in he cases
o he maxilla y plane (11.08 ° ± 1.87º, P <0.01), o he
mandibula plane (-13.95%, p<0.0001) and he amus
Table 2. Ages o males and emales in he 1s , 2nd and 3 d measu emen s.
1s measu emen 2nd measu emen 3 d measu emen
FEMALE 18.75 y s ± 0.80 21.10 y s ± 0.92 28.89 y s ± 0.71
MALE 20.20 y s ± 0.44 22.3 y s ± 0.75 29.50 y s ±0.93
DIFFERENCE p< 0.01* p<0.01* p<0.6
MEAN AGE
RAGE
19 y s
18-21 y s
21 y s
19-23 y s
29 y s
27-31 y s
Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41. Long- ace synd ome
e439
Table 3. Angula alues o he sample a he di e en measu emen poin s(1s , 2nd and 3 d measu emen ).
Measu emen Angula  alue Mean
(deg ee)
Typical
de ia ion
MiniumMaxium


1s 
measu emen 
SAGITAL
CHANGE
SNA76.42 2.68 7380.5
SNB79.24 3.66 7380.5
ANBͲ2.82 2.28 Ͳ6Ͳ0.5
VERTICAL
CHANGE
SN/ANSͲPNS 12.45 3.03 617
SN/GoͲGn 84.76 1.61 8288
GoͲA /GoͲGn 141.89 3.30 129150
GoͲA /GoͲGn 45.79 5.18 3454
SN/SͲGn 70.84 3.37 6677


2nd
measu emen 
SAGITAL
CHANGE
SNA80.39 3.20 76.586
SNB77.61 3.77 7185
ANB2.79 2.04 Ͳ25.5
VERTICAL
CHANGE
SN/ANSͲPNS 11.08 1.87 814
SN/GoͲGn 83.13 1.43 8186
GoͲA /GoͲGn 136.34 3.30 129141
GoͲA /GoͲGn 39.39 4.10 3446
SN/SͲGn 70.29 3.63 6677


3 d
measu emen 
SAGITAL
CHANGE
SNA78.76 3.22 7484.5
SNB77.92 3.83 71.585
ANBͲ0.84 2.48 Ͳ35
VERTICAL
CHANGE
SN/ANSͲPNS 11.89 2.75 7.517
SN/GoͲGn 85.24 1.88 8088.5
GoͲA /GoͲGn 138.29 3.75 130143.5
GoͲA /GoͲGn 43.21 2.73 3847.5
SN/SͲGn 71.03 3.56 6375

Table 4. Changes obse ed in he alues ob ained a he di e en measu emen poin s.
Compa ison
o
measu emen s
Angula
alue
Mean
change
(deg ees)
Typical
de ia ion
Mean
change
(%)
Minium
change
Maxium
change
S a is ical
signi icance o
change
Di e ences
1s -2nd
measu emen s
SAGITAL
CHANGE
SNA 3.97 2.14 5.2 1 9 ***
SNB -1.63 1.09 -2.05 -3 0.5 ***
ANB 5.61 2.16 198.93 2 10 ***
VERTICAL
CHANGE
SN/ANS-PNS -1.37 2.31 -11 -6 2 **
SN/Go-Gn -1.63 0.74 -1.92 -3 0 ***
Go-A /Go-Gn -5.55 3.84 -3.91 -12.5 0 ***
Go-A /Go-Gn -6.39 2.66 -13.95 -10 0 ***
SN/S-Gn -0.55 1.87 0.77 -3 3.5 NS
Di e ences
2nd-3 d
measu emen s
SAGITAL
CHANGE
SNA -1.63 1.96 -2.07 -7 0.5 **
SNB 0.32 1.52 0.41 -2 4 NS
ANB -1.95 1.09 69.89 3 0.5 **
VERTICAL
CHANGE
SN/ANS-PNS 0.82 1.66 7.40 -1 4 *
SN/Go-Gn 2.11 1.40 2.53 -1 4 NS
Go-A /Go-Gn 1.95 1.40 1.43 0 5 ***
Go-A /Go-Gn 3.82 2.51 9.69 1 8 ***
SN/S-Gn 0.74 1.58 1.05 1 4.5 NS
Di e ences
1s -3 d
measu emen s
SAGITAL
CHANGE
SNA 2.34 2.67 3.06 -3.5 6.5 **
SNB -1.32 1.78 -1.26 -4.5 2 **
ANB 3.66 2.61 129.78 -3.5 7 **
VERTICAL
CHANGE
SN/ANS-PNS -0.55 3.14 -3.61 -7 4.5 NS
SN/Go-Gn 0.47 1.12 0.55 -2.5 2.5 ***
Go-A /Go-Gn -3.61 2.65 -2.54 -8.5 1 ***
Go-A /Go-Gn -2.58 3.44 -5.63 9 6 **
SN/S-Gn 0.18 2.32 0.25 -4 4 NS

(A “p” alue highe han 0.05 appea s as NS and does no ha e s a is ical signi icance; be ween 0.01 and < 0.05*, be ween 0.001 and < 0.01**
and less han 0.001 as ***).

Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41. Long- ace synd ome
e440
plane (83.13° ± 1.43º, p <0.0001), no mal and s a is ical-
ly signi ican alues a e app oached, hey do no qui e
each no mal ones.
The changes occu ed in he amus plane (inc eased
2.53 º, + 2.11%, which, despi e i s lack o s a is ical
signi icance, p esen s a loss o 130% in he educ ion
achie ed a e su ge y), he mandibula angle (+35.13%
o he educ ion ob ained a e su ge y, p<0.0001) and
he mandibula plane (inc ease o 3.82º, a loss o almos
60% educ ion a e su ge y, p <0.0001).
Discussion
On analyzing he li e a u e we no iced how di icul i
is o combine he h ee mos impo an aspec s, i.e. ho-
mogenei y, sample size and leng hy ollow-up pe iod in
hese ypes o s udies. S udies wi h leng hy ollow-up
pe iods and a homogeneous sample end o be o small
sample size, whe eas la ge samples sizes a e usually
mo e he e ogeneous wi h a sho e ollow-up pe iod.
19 pa ien s pa icipa ed in his s udy; 14 emale and 5
male. Bo h he clinical and s a is ical esul s ob ained
ha e demons a ed he alue and quali y o his sample
o ob aining s a is ically signi ican esul s.
Thus, in con as o he mos signi ican cha ac e is ic o
he p esen s udy, he mean ollow-up pe iod (7.6 yea s),
and he speci ic na u e o he sample (class III long- ace
synd ome), mos s udies dealing wi h hese aspec s in-
clude samples o no mo e han 20 pa ien s (17,18). O he
s udies wi h samples o mo e han 20 pa ien s a e no so
sample-speci ic (9) o ha e a mean ollow-up pe iod o
less han 6 yea s (19,20).
Ou pa ien s had a no mal SNB angle due o mandibu-
la pos e o o a ion ha usually accompanies class III
malocclusion and causes poin B o occupy a lowe and
pos e io spa ial loca ion. The dec ease o he maxil-
la y plane and he inc ease o he mandibula plane can
be in e p e ed as a mandibula pos e o o a ion, his
being logical in dolicho acial pa ien s. The acial axis
indica es once again he cha ac e is ic pos e o o a ion
o dolicho acial pa ien s. In he 2nd measu emen s, he
angle SNB was s ill ou side he ange o no mal e e -
ence. In ou iew, his alue has been a ec ed mo e by
he sagi al e usion o poin B ollowing mandibula
eg ession han by he ad ance o he same due o an-
e o o a ion. Hoppen eijs e al. (21) ound, howe e , an
inc ease o 2.74º in he SNB. A e su ge y, he angle
ANB inc eased 5.61° (+198.93%, p <0.0001), esul s
simila o hose o Cos a e al. (22), who ound an in-
c ease o 5.47º.
The mandibula angle dec eased by 3.91% (p <0.0001),
a su gical an e o o a ion o he dis al segmen a e
os eo omy aking place. Mo eo e , he acial axis de-
c eased by -0.55º, being he smalles change (-0.77%)
wi hou s a is ical signi icance o clinical epe cussions.
In sho , he o e all analysis o changes a e su ge y
shows ha , excep o he maxilla y plane and acial
axis, all o he a iables p esen highly s a is ically sig-
ni ican changes. Thus, changes in he pa ame e s show
a sagi al ad ance o he maxilla (inc eased SNA), a
sagi al mandibula eg ession ( educed SNB) and man-
dibula an e o o a ion (dec eased le el o he b anch,
he mandibula angle and mandibula plane). Simila ly,
he angle ANB inc eases and adequa ely si ua es he
maxilla in ela ions o he mandible.
Rega ding he changes o alues be ween he 2nd and
3 d obse a ion, i.e. he loss o he p og ess made wi h
su ge y in he long e m, ou da a indica es ha , in gen-
e al, he e was a elapse o g ea clinical and s a is ical
signi icance in some o he cephalome ic pa ame e s
s udied ela ing o he e ical cha ac e is ics o he sam-
ple: on he amus plane, on he mandibula angle and on
he mandibula plane. These da a exp ess a e u n o
he jaw o pa ame e s ha e lec hei pos e o o a ion
and e icali y. Howe e , he e is no such a ma ked
elapse in e ms o he sagi al posi ion o he mandi-
ble (SNB, wi h a change o ba ely 0.41% in i s alue
and 19.63% in he su ge y¬induced change) and i s e-
la ionship o he maxilla. Au ho s such as Cos a e al.
(22) ound an inc ease o 0.92° in a yea (42.59% o he
change achie ed wi h su ge y, -2.16°), while Dowling
e al. (23) ound no change in he SNB a e 3 yea s, al-
hough hey we e only conside ing he uppe jaw. While
he change in ANB is s a is ically signi ican ( educed
by 1.95°, -69.89% o he absolu e alue o he pa ame e ,
p <0.01), his is caused mo e by he loss o he sagi al
loca ion o poin A han by poin B (SNA p esen s a sig-
ni ican a ia ion in his compa ison, some hing which
does no occu in SNB). The alue o his change a e
moni o ing shows again a posi ion o abno mali y wi h
ega d o he in e maxilla y sagi al ela ionship, wi h
he maxilla loca ed oughly on he same sagi al le el
as he mandible. In his, ou s udy is in ag eemen wi h
hose o Dowling e al. (23) and Cos a e al. (22). Finally,
changes in he maxilla y plane o acial axis a e clini-
cally negligible, al hough he o me p esen s s a is ical
signi icance while he la e does no . I may, he e o e,
be s a ed ha he e is li le a ia ion in acial axis, which
is s ill abo e no mal alues, e lec ing he dolicho acial
pa e n. I we analyze he changes ha ha e aken place
wi h ega d o he ini ial si ua ion in ou sample, despi e
he losses in he pos ope a i e pe iod, we ind ha , wi h
he excep ion o he maxilla y plane and acial axis, all
o he a iables showed s a is ically signi ican changes,
some o a g ea e ex en han o he s. The sagi al lo-
ca ion o he maxilla e ains a signi ican ly a o able
change (p <0.0001), hanks o imp o ed sagi al posi-
ion o he maxilla (inc ease o he SNA, +3.06%, p
<0.01) and o he mandible (SNB educ ion, -1.26%, p
<0.01). As a esul , he in e maxilla y sagi al ela ion-
ship (ANB) main ains a change o maximum s a is i-
Med O al Pa ol O al Ci Bucal. 2012 May 1;17 (3):e435-41. Long- ace synd ome
e441
cal signi icance (+129.78%, p <0.0001) and, al hough
no wi hin he pa ame e s o absolu e no mali y, i does
manage o si ua e he maxilla on he same sagi al le el
as he mandible. Simila ly, he pa ame e s ela ing o
an e o o a ion co ec ion o he mandible s ill show a
change o g ea signi icance ( he amus plane (-5.63%,
p <0.01), he mandibula plane (+0.55%, p <0.0001) and
he mandibula angle (-2.54%, p <0.0001). These chang-
es a e in line, bu o a lesse ex en , o ha achie ed a e
su ge y in he co ec ion o skele al Class III malocclu-
sion and dolicho acial pa e n. The e o e, he changes
in he pa ame e s demons a e an ad ance o he max-
illa, a mandibula eg ession and an an e o o a ion o
he mandible. E en hough he changes a e s a is ically
signi ican , hey a e no clinically signi ican . Finally,
we ha e o keep in mind ha he sample is small and
ha esul s canno be gene alized.
In conclusions, 1.- Skele al changes a e o hodon ic-
su gical co ec ion p esen maxilla y ad ance, man-
dibula eg ession and mandibula an e o o a ion, and,
2.- The h ee angles ha ep esen he mandibula e i-
cal posi ion ( amus angle, goniac angle and mandibula
plane angle) showed s a is ically signi ican elapses
and no s abili y in con as o he acial axis.
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