To consider the diet and nutritional intake after surgery, this study investigated the status of the nutritional intake of patients who underwent orthognathic surgery and how they felt about the post-surgical diet using a questionnaire. Fourteen subjects （2 males and 12 females; average age 27.6 years） underwent orthognathic surgery at Oita Oka Hospital between November and the end of December 2017. The questionnaire had nine questions, including on the appearance of meals and so on. The patients were asked to fill in the questionnaire before being discharged. We recorded the dietary intake rate of meals provided for 3 days after surgery to calculate the amount of energy consumed and the nutrient adequacy based on the required amount of energy. This gave us an accurate picture of the dietary and nutritional intake situation. According to the questionnaire, 92% of patients said that the meals provided were easy or somewhat easy to eat. Regarding satisfaction with the diet, all patients answered that they were satisfied. However, regarding the appearance, 44% of the patients said that the meals provided were not very visually appealing, and 47% said the dietary amount was too much. The average amount of energy consumed for the 3 days after surgery was 705 kcal and the average nutrient adequacy was 35%.
These results showed that the nutritional intake situation of patients who underwent orthognathic surgery was about three out of ten in terms of nutrient adequacy. Many patients felt the meals were easy to eat and were satisfied with the food currently offered by our department, but they felt that they had physical difficulties eating, and that the meal volume was large, which is considered to be a low nutrient adequacy.

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In mandibular protrusion cases who undergo short lingual osteotomy（SL）, interference between the distal mandibular segment and medial pterygoid muscle（MPM）is occasionally seen at setback operation. The interference causes posterior deviation of the mesial mandibular segment and affects the postoperative stability. Thus, the relationship between the MPM and the mesial segment was examined three-dimensionally using preoperative CT images.
In this study, 18 cases of mandibular protrusion（7 males and 11 females, average age at first visit: 22.4 years old）who visited Meikai University Hospital were examined. All cases were not affected by any congenital anomalies, and the lateral deviation of Me was within 3mm. Lateral cephalograms were taken immediately before surgery（T1）, less than 5 weeks after surgery （T2）, and more than 1 year after surgery（T3）. CTs were taken at T1. Seven of the 18 cases showed postoperative anterior relapse of more than 2.0mm at Me from T2 to T3（group U）. The relapse of the other 11 cases（group S）was 2.0mm or less. Using DICOM data of CT, MTM was reconstructed three-dimensionally, and the relationship with the mesial mandibular segment was analyzed.
There was no significant difference in the amount of mandibular setback and decrease in SNB angle between group S and group U from T1 to T2. Group U, but not group S, showed posterior deviation of the mesial mandibular segment from T1 to T2. MPM was significantly inclined less laterally in group U than group S at T1, indicating that cases in group U exhibited closer proximity of MPM to the mandibular ramus.
These findings suggest that the proximity of MPM to the mandibular ramus at T1 is one of the risk factors causing interference, and affects the postoperative stability when performing SL. Simulation of MTM, together with the mandible, is informative in predicting postoperative stability at SSRO.

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Sagittal split ramus osteotomy（SSRO）is an effective orthognathic surgery used to correct mandibular deformity. Neurosensory disturbance（NSD）of the inferior alveolar nerve（IAN）is a common complication after SSRO. This clinical study aimed to evaluate NSD after SSRO using a tactile-threshold test by Semmes-Weinstein monofilaments（SW test）and an interview about the subjective symptoms（Subjective test）and to analyze several factors regarding their possible influence on NSD. A total of 80 patients（160 sides）who underwent SSRO were examined before surgery and at 7 days, 4 weeks, 3 months and 6 months after surgery. The incidence of NSD was found in 35.0％by the SW test and in 29.4％ by the Subjective test at 7 days after surgery. These were classified into four levels（Normal, Level 1 to 3）by the SW test and two groups（Light/Severe group）by the Subjective test. Each level and group gradually returned to normal by 6 months after surgery. 25％ of the Severe group presented NSD on all of 3 evaluated zones of the mental nerve at 7 days after surgery and 50％ of the Severe group still showed relatively wide zones at 4 weeks after surgery. A significantly higher incidence of NSD at 7 days after surgery was observed on intraoperative nerve encounter in the SW test and mandibular advancement in the Subjective test. The comparison between gender, age and osteotomy method did not show any significant difference. The results suggest that SSRO has the disadvantage of temporary NSD. However, when patients are considered and that the Severe group still showed NSD on a wide zone at 4 weeks after surgery, the delay in recovery should be kept in mind. Our study concluded that NSD after SSRO is strongly associated with IAN nerve exposure and mandibular advancement.

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The purpose of this retrospective study was to examine borderline cases between surgical orthodontic treatment and orthodontic treatment with the Index of Orthognathic Functional Treatment Need （IOFTN）. The subjects were 184 patients who underwent surgical orthodontic treatment or orthodontic treatment without orthognathic surgery in our hospital （Niigata University Medical and Dental Hospital） during the period from January 2015 to December 2017. The subjects were divided into three groups: the surgical orthodontic treatment group （SO group） consisted of 92 patients （29 males and 63 females, mean age ± SD: 24 ± 8 years）. The skeletal anchorage system group （SA group） consisted of 41 patients （13 males and 28 females, mean age ± SD: 26 ± 8 years） treated by orthodontic treatment combined with skeletal anchorage. The conventional orthodontic treatment group （CO group） consisted of 51 patients （19 males and 32 females, mean age ± SD: 23 ± 8 years）. In the SO group, a combination of Le Fort I osteotomy and bilateral sagittal split osteotomy was used in 62 cases （67.4％）, bilateral sagittal split osteotomy in 20 cases （21.7％）, a combination of multi-segmental Le Fort I osteotomy and bilateral sagittal split osteotomy in six cases （6.5％）, and other techniques were used in four cases （4.4％）. In the SA group, orthodontic anchor screws and orthodontic anchor plates were used in 33 cases and eight cases, respectively. The ANB angle was measured to classify the skeletal pattern as follows: Class 1 （1 ≤ ANB ≤ 4）, Class 2 （ANB > 4）, and Class 3 （ANB < 1）.
The results showed that Class 3 accounted for 57.6％ of the cases in the SO group and Class 2 accounted for 48.8％ of the cases in the SA group, and most of the cases in the CO group were Class 1 and 2. In the SA and CO groups, some cases with maxillary protrusion and/or mandibular retrusion were treated by only orthodontic treatment, even if surgical orthodontic treatment was indicated for those cases based on IOFTN. These results suggest that cases with maxillary protrusion or/and mandibular retrognathia might be borderline between surgical orthodontic treatment and orthodontic treatment.

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We report a case of skeletal mandibular protrusion with dwarfed teeth treated by dental decompensation using anchor screws. The patient was a female aged 18 years and 5 months at the first visit with the chief complaint of mandibular protrusion and space between maxillary anterior teeth. She had a concave facial profile with slight midfacial concavity. ∠ANB was −6.0°, ∠SNA was 78.5° and ∠SNB was 84.5°. The intraoral view showed anterior and posterior crossbite. The molar relationship was Angle ClassⅢ. Lower incisors showed lingual inclination because of dental compensation. In the conventional treatment, labial tipping of the lower incisors was likely to generate interdental spaces in the mandibular arch with mild crowding. Subsequently, in the process of closing spaces, retroclination of the incisors was frequently seen. In the present case, we used orthodontic anchor screws to maintain the lower incisor angle during presurgical orthodontic treatment. After 14 months of preoperative orthodontic treatment, Le FortⅠ osteotomy and intraoral vertical osteotomy（IVRO）were performed. As a result, the mandibular incisors were inclined labially by 7.0°. The posterior part of the maxilla was moved superiorly by 4.5mm and the mandible was set back by 11.5mm at the menton. The crossbite and concave facial profile were improved by the appropriate amount of mandibular set-back. Additionally, condylar movement and incisal paths（opening and closing, lateral excursive movements）were also improved at 25 months after the initiation of retention.

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