This article reviews unexpected vascular complications resulting from orthognathic surgery, which could lead to a serious situation such as massive hemorrhage and cranial nerve disturbance. Firstly, the clinical course of our patient with arteriovenous malformation （AVM） preexisting in the maxillary arterial area is reported, with a review of the literature on AVM. The lesion was diagnosed through the symptoms of disturbance of facial and lingual nerves followed by pulsating tinnitus and facial swelling occurring after orthognathic surgery. It was successfully treated by embolization with N-butyl-2-cyanoacrylate monomer （NBCA）. In addition, we reviewed the literature on pseudoaneurysms （PA） and arteriovenous fistulas （AVF） resulting from orthognathic surgery. Consequently, we clarified the clinical symptoms, treatment strategy, and pathogenesis of AVM, PA, and AVF, and propose specific measures to prevent vascular injury during orthognathic surgery.

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A clinical survey was performed on 252 patients who underwent orthognathic surgery at the Department of Oral and Maxillofacial Surgery, Chubu Rosai Hospital, during the 7 years from April 1, 2017 to December 31, 2023. The results were as follows.
1．During the 7 years, 252 patients （74 males and 178 females） with dentofacial deformities underwent orthognathic surgery.
2．The average age of the patients was 27.7±7.4 years old （16-57）. Patients in their twenties accounted for the largest number （53.6％）.
3．The most common diagnosis was mandibular asymmetry＋mandibular prognathism （25.8％）, followed by mandibular prognathism （21.0％）.
4．The most frequently performed operation was sagittal split ramus osteotomy （SSRO）, accounting for 133 cases （52.8％）, followed by the combination of Le Fort Ⅰ osteotomy and SSRO （LF1＋SSRO） with 55 cases （21.8％）.
5．The average operation time and amount of bleeding for SSRO were 209±38 minutes and 130±121mL, and those for LF1＋SSRO were 366±85 minutes and 336±244mL, respectively.
6．The mean hospital stay was 11±3.0 days in SSRO and 15±3.8 days in LF1＋SSRO.
7．The number of clinics referring patients to our department increased yearly.
8．The most common intraoperative and postoperative complications were inferior alveolar nerve palsy with 65 cases （25.8％） and postoperative nausea with 65 cases （25.8％）.

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In orthognathic surgery, it is important for treatment planning to predict postoperative changes from preoperative facial appearance. These changes can be estimated by superimposing two-dimensional lateral cephalograms and lateral facial photographs or by using X-ray CT images; however, radiation exposure and soft tissue reproducibility must also be considered. Three-dimensional （3D） imaging techniques, such as 3D photographic images, can accurately record and reproduce soft tissue in 3D without exposing patients to radiation. In this study, we compared soft tissue changes in preoperative and postoperative 3D photographic images with the amount of jawbone movement and investigated whether there was a correlation between the two.
Twenty patients, diagnosed with skeletal prognathism and who underwent orthognathic surgery, were included in the study and divided into two groups: the symmetry and asymmetry groups. Soft tissue 3D images were constructed from images taken from three angles using a 3D image capture and analysis device with dedicated software. The amount of soft tissue change was determined in the preoperative and postoperative soft tissue 3D images and the lateral movements of Me and soft tissue Me in the frontal plane were compared. The examination items included 1） comparison of the lateral movement of Me and soft tissue Me in the frontal plane, 2） comparison of the anteroposterior movement of Me and soft tissue Me in the sagittal plane, and 3） comparison of the lateral movement of the left and right maxillary first molar buccal cusps and intersection between Camper’s plane and a line connecting the external eye canthus with the labial commissura in the frontal plane.
A strong correlation was observed for both the symmetry and asymmetry groups in item 1）. In item 2）, a strong correlation was observed in the symmetry group. In contrast, no significant correlation was found in the asymmetry group, and in item 3）, no significant correlation was identified in either the symmetry or asymmetry groups.
The results of this study suggest that 3D photographic imaging may be a useful addition to the existing materials required for orthodontic treatment, which can be easily added without radiation exposure.

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