In order to identify trends among orthognathic surgery patients who visited the Department of Orthodontics at Aichi-Gakuin University Hospital for the 10 years from January 1999 to December 2008, we performed a statistical survey. We examined differences in the maxillofacial morphology of patients with anterior crossbite and maxillary protrusion who had orthognathic surgery or orthodontic treatment.
The results were as follows:
1. Among a total of 3,065 patients, the number of patients with jaw deformities was 295 (9.6%), comprising 127 (43.1%) male and 168 (56.9%) female patients.
2. The average number of patients per year was 29.5.
3. Anterior crossbite (147 cases, 49.9%) was the most prevalent condition, followed by anterior crossbite+ open bite (65 cases, 22.0%).
4. The average age at diagnosis was 23y5m±7y1m. For males, it was 22y10m±7y0m, and for females, 23y10m±7y0m (mean±S.D.).
5. The average ANB for jaw-deformity patients was −3.3±3.1° mandibular protrusion and +7.7±2.7° maxillary protrusion.
6. The average overjet for jaw deformity patients was −2.7mm±3.0mm mandibular protrusion and 8.3mm ±3.7mm maxillary protrusion.

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A survey was carried out on the cases of sagittal split ramus osteotomy (SSRO) in the Nagano Red Cross Hospital.
The results were as follows:
1. SSRO was performed on 270 patients from 1986 to 2009.
2. The mean age at surgery was 22±5.8 years old.
3. The male-female ratio was 1:2.3.
4. The diagnosis of mandibular prognathism was made for most patients (76.3%).
5. Osteosynthesis of bone fragments was done as follows: 55 patients by wire fixation, 61 patients by fixation with titanium miniplate, and 154 patients by fixation with bioabsorbable miniplate.
6. The mean operation time was 113±34 min.
7. The mean amount of bleeding was 284±205 g.
8. Blood transfusion was done in 6 cases (2.2%).
9. The incidence of surgical complications was as follows: inferior alveolar nerve disturbance occurred in 130 cases (48.1%), trouble of osteosynthesis in 25 cases (9.3%), unfavorable fracture in 17 cases (6.3%), and abnormal bleeding in 13 cases (4.8%).
10. Orthodontic treatment was done in 260 cases (96.3%).
11. The mean duration of hospital stay was 14.7±3.9 days.

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The present study investigated the pattern of muscle activity during swallowing in patients with mandibular prognathism.
The subjects comprised 12 mandibular prognathism patients (5 males, 7 females, average age of 20.8 years old), and 12 volunteers (2 males, 10 females, average age of 23.8 years old) with individual normal occlusion and no abnormalities of deglutition function as a control.
Electromyographic (EMG) activity was recorded from the masseter and suprahyoid muscles bilaterally, mentalis on the midline and orbicularis oris and infrahyoid muscles on the right side.
Each subject was asked to perform the following: (1) maximum clenching for 5 seconds at 10-second intervals, (2) maximum jaw opening for 5 seconds at 10-second intervals, and (3) swallow 4 ml of half-solid nutrient made of 0.8% agar powder. The first two tasks were repeated four times and the last one was repeated five times.
Peak amplitudes of masseter and suprahyoid EMGs during maximum clenching and jaw opening were first obtained. For analysis of swallowing, mean values of duration of EMG, mean values of amplitude, and root mean square (RMS) of EMGs of orbicularis oris, mentalis and infrahyoid muscles, and those of %peak (swallow activity/peak activity) amplitude of masseter and suprahyoid EMGs were calculated and compared between the patient group and the normal group. Morphological characteristics of the patients were also compared between the groups using lateral cephalograms.
The duration of activity in all muscles recorded except the infrahyoid was significantly longer in the patient group than in the control. Peak amplitude and RMS of mentalis muscles were significantly larger in the control than in the patient group. %peak amplitude of masseter and suprahyoid muscles were both significantly larger in the patient group than in the control. On the contrary, there were no significant differences in all the variables of infrahyoid muscles.
The present study successfully showed the pattern of orofacial muscle activity in patients with mandibular prognathism in terms of peak amplitude and duration. Although the activities of orofacial muscles recorded in this study are reflexively controlled at the lower brainstem during swallowing, these are also known to be voluntary muscles and therefore they are likely to adapt the activity patterns to their morphologic characteristics.

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A clinical outcome was performed on 243 cases of orthognathic surgery at the Department of Oral and Maxillofacial Surgery, Miyazaki University Hospital from 2000 to 2009.
The results were as follows:
1. The total number of patients was 243 cases, and the average annual number of patients was 24.3.
2. The patients were 102 males and 141 females (male to female ratio of 1:1.38).
3. The age of the patients ranged from 9 to 58 years old with a mean of 21.1 years old.
4. The most predominant diagnosis was mandibular prognathism (70.8%), in which those with and without another type of jaw deformity were 21.4% and 49.4%, respectively.
5. Sagittal splitting ramus osteotomy (SSRO) alone was the most frequent surgical procedure, accounting for 89.7%.
6. The PLLA plate and the titanium miniplate for osteosynthesis during SSRO were used for 87.6% and 12.4%, respectively.

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We investigated the trend of patients with jaw deformity in the past decade at Niigata University Medical and Dental Hospital. We also compared the present results with those of our previous report in 2000. The subjects consisted of 525 jaw-deformity patients registered at the Department of Orthodontics, Niigata University Medical and Dental Hospital between January 2000 and December 2009. The number of subjects who underwent orthognathic surgery in our hospital was 767 in the same ten-year period.
The items examined were as follows:
I. Ratio of jaw-deformity patients to all new outpatients registered
II. Sources which referred jaw-deformity patients to our department and reference rate
III. Annual number of jaw-deformity patients and gender distribution
IV. Age of patients at the first examination and at the start of presurgical orthodontic treatment
V. Classification of malocclusion at the first examination
VI. Chief complaints of the patients
VII. Number of orthognathic surgeries and their procedures.
The ratio of jaw-deformity patients to all new outpatients registered from 2000 to 2009 was approximately 20%, among whom jaw-deformity patients introduced by other hospitals accounted for 82.1%. Both ratios were slightly higher than in our previous investigation in 2000. In terms of annual changes in jaw-deformity patients, the number of patients tended to decrease after a peak of 75 in 2002, and then slightly increased after 2007. The ratio of males to females was about 1:2. Regarding the age at first examination and the start of presurgical orthodontic treatment, most of the patients involved were from 14 to 19 years old.
Mandibular prognathism accounted for 63.5%, which was the most frequent antero-posterior malocclusion in the examined patients. Concerning vertical and horizontal malocclusions, open bite and midline deviation were the most frequent with 25.0% and 48.6%, respectively.
As for chief complaints, 55.2% of the complaints concerned malalignment, followed by facial appearance, masticatory disturbance, TMJ disturbance, opinions of other persons, pronunciation disorder, and others. However, the ratio of patients who regarded improvement of the face as one of the chief complaint was very high, at 79.4%, compared with the previous results in 2000.
In terms of surgical procedure, two-jaw surgery was the frequent method accounting for 50-65%. It was especially high in 2009 (77.4%).
According to the requests of patients, it is considered that two-jaw surgery may increase in the future.

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We report a case of Kabuki make-up syndrome associated with cleft lip and palate. The female patient was 18 years old at the time of surgery. She was diagnosed with Kabuki make-up syndrome at 7 months old. In addition to characteristic facial dysmorphic features, mental deficiency, atrial septal defect and short stature were found. During growth hormone treatment for short stature, mandibular prognathism was found. There was no internal and hematological disease except for atrial septal defect, and mental deficiency was not severe, therefore a surgical orthodontic procedure was performed uneventfully and postoperative stability was good.

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Growth hormone deficiency (GHD) is the deficiency of growth hormone produced by the pituitary gland to stimulate the body to grow. We report a case of GHD with severe mandibular protrusion and masseter hypertrophy. A 28-year-old male patient with GHD treated with administration of human growth hormone between the ages of 11 to 20 visited our hospital because of severe mandibular protrusion and malocclusion. The patient had a history of orthodontic treatment for skeletal Class III malocclusion from 9 to 14 years old. Clinical evaluation revealed a concave profile with severe mandibular protrusion and a prominent mandibular angle. After preoperative orthodontic treatment, a combination of Le Fort I osteotomy, anterior mandibular segmental osteotomy, and bilateral sagittal split ramus osteotomy was performed. Eight months after the first surgery, the lower and inner portions of the bilateral masseter muscles were resected and the expanded portions of the mandibular angles were trimmed away by an intraoral approach. After orthognathic surgery, the facial profile and malocclusion were improved remarkably.
Untreated patients with GHD have typical somatic features, including short stature, acromicria, and distinctive craniofacial features including small head circumference and retrognathism. It is reported that GH therapy partially corrects craniofacial defects but long-term GH therapy might be associated with acromegalic features. In the present case, it is suggested that GH therapy accelerated mandibular growth and aggravated mandibular protrusion.

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