A 19-year-old male with Marfan syndrome (MFS) was referred to our hospital for improvement of his facial asymmetry. Orthognathic surgery was planned because the cardiovascular and thoracic abnormalities were relatively mild. The patient initially underwent pre-operative orthodontic treatment, and then the surgery was performed under careful control of the cardiovascular and pulmonary function. After a combination of Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy, a distractor was placed on the hypoplastic side of the maxilla. The activation of the distractor resulted in gradual rotation of the maxillomandibular complex using intermaxillary fixation. This allowed decanting of the occlusal plane with displacement of the chin position to the opposite side, leading to an improvement in the facial asymmetry. The postoperative course was uneventful. Over a follow-up period of 11 years, the facial symmetry and the occlusion have been stable.
