{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T19:57:41Z","timestamp":1782935861968,"version":"3.54.5"},"reference-count":52,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Mid-term skeletal stability after bimaxillary orthognathic surgery in patients with facial asymmetry and a relatively normal sagittal skeletal relationship (ANB \u2248 1\u20134\u00b0) remains underreported. This study aimed to determine the three-dimensional characteristics and temporal changes in postoperative skeletal remodeling and symmetry maintenance in such patients. Materials and Methods: This retrospective case series included 25 patients (ANB \u2248 1\u20134\u00b0) undergoing bimaxillary orthognathic surgery. Three-dimensional computed tomography was performed preoperatively (T0), immediately postoperatively (T1), and at 6\u201312 months postoperatively (T2) to quantify bilateral condylar, ramus, mandibular body, maxillary parameters, and occlusal cant. Statistical analyses were performed using appropriate statistical methods for paired and repeated-measures designs. Results: Preoperatively, the long side exhibited significantly greater condylar volume, ramus height, and mandibular body length than the short side (all p &lt; 0.05). Postoperatively, a \u201clong-side reduction and short-side augmentation\u201d strategy significantly reduced or reversed most bilateral differences, with a marked improvement in occlusal plane cant (p &lt; 0.01). At T2, only mild bone remodeling was observed, with no significant loss of postoperative skeletal symmetry. The occlusal plane remained stable. Conclusions: In patients without marked sagittal discrepancies, bimaxillary orthognathic surgery effectively restores transverse and vertical skeletal symmetry. Mid-term stability is well maintained over 6\u201312 months, with only mild condylar and ramus remodeling, suggesting adaptive remodeling rather than relapse.<\/jats:p>","DOI":"10.3390\/medicina62020372","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T09:09:19Z","timestamp":1770973759000},"page":"372","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bimaxillary Orthognathic Surgery for Facial Asymmetry with Near-Normal Sagittal Relationship: Mid-Term Stability and Remodeling"],"prefix":"10.3390","volume":"62","author":[{"given":"Yuhung","family":"Lin","sequence":"first","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyu","family":"Liao","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfeng","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","first-page":"171","article-title":"The prevalence of facial asymmetry in the dentofacial deformities population at the University of North Carolina","volume":"12","author":"Severt","year":"1997","journal-title":"Int. J. Adult Orthod. Orthognath. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"118","DOI":"10.2319\/040921-292.1","article-title":"Prevalence of mandibular asymmetry in different skeletal sagittal patterns","volume":"92","author":"Evangelista","year":"2022","journal-title":"Angle Orthod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e199","DOI":"10.1097\/SCS.0000000000003371","article-title":"Prevalence and Associated Factors of Mandibular Asymmetry in an Adult Population","volume":"28","author":"Thiesen","year":"2017","journal-title":"J. Craniofacial Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"803","DOI":"10.2319\/092506-392","article-title":"Mandibular asymmetry in different occlusion patterns","volume":"77","author":"Sezgin","year":"2007","journal-title":"Angle Orthod."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Zammit, D., Ettinger, R.E., Sanati-Mehrizy, P., and Susarla, S.M. (2023). Current Trends in Orthognathic Surgery. Medicina, 59.","DOI":"10.3390\/medicina59122100"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"481","DOI":"10.4103\/jispcd.JISPCD_130_21","article-title":"Correlations Between Mandibular Asymmetries and Temporomandibular Disorders: A Systematic Review","volume":"11","author":"Alqhtani","year":"2021","journal-title":"J. Int. Soc. Prev. Community Dent."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Alm\u0103\u0219an, O., Leucu\u021ba, D.C., and Buduru, S. (2022). Disc Displacement of the Temporomandibular Joint and Facial Asymmetry in Children and Adolescents: A Systematic Review and Meta-Analysis. Children, 9.","DOI":"10.3390\/children9091297"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.bjoms.2024.09.001","article-title":"Three-dimensional changes in the mandibular condyle in skeletal class III patients treated with orthognathic surgery: A systematic review","volume":"62","author":"Kalluf","year":"2024","journal-title":"Br. J. Oral. Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.jds.2023.09.025","article-title":"Three-dimensional evaluation of skeletal stability after surgery-first bimaxillary surgery for class III asymmetry in 70 consecutive patients","volume":"19","author":"Atipatyakul","year":"2024","journal-title":"J. Dent. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4947","DOI":"10.1007\/s00784-022-04463-4","article-title":"Three-dimensional assessment of facial asymmetry in Class III subjects. Part 1: A retrospective study evaluating postsurgical outcomes","volume":"26","author":"Ajmera","year":"2022","journal-title":"Clin. Oral. Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"89","DOI":"10.4041\/kjod23.194","article-title":"Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis","volume":"54","author":"Kim","year":"2024","journal-title":"Korean J. Orthod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.joms.2011.08.028","article-title":"Do patients treated with bimaxillary surgery have more stable condylar positions than those who have undergone single-jaw surgery?","volume":"70","author":"Kim","year":"2012","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.ajodo.2023.09.016","article-title":"Enhancing skeletal stability and Class III correction through active o rthodontist engagement in virtual surgical planning: A voxel-based 3-d imensional analysis","volume":"165","author":"Barone","year":"2024","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/ocr.12456","article-title":"Stability of single-jaw vs two-jaw surgery following the correction of skeletal class III malocclusion: A systematic review and meta-analysis","volume":"24","author":"Rizk","year":"2021","journal-title":"Orthod. Craniofacial Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ijom.2025.06.016","article-title":"Evaluation of post-surgical outcomes in mandibular asymmetry with three-dimensional cephalometric analysis","volume":"55","author":"Chan","year":"2025","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ijom.2005.04.006","article-title":"A comparison of craniofacial morphology in patients with and without facial asymmetry--a three-dimensional analysis with computed tomography","volume":"35","author":"Kwon","year":"2006","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.joms.2011.02.135","article-title":"Morphologic evaluation and classification of facial asymmetry using 3-dimensional computed tomography","volume":"70","author":"Baek","year":"2012","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Liu, Y., and Li, Y. (2022). BSSRO Improves Mandibular Morphology Mainly through Correction of Body Length and Volume in Patients with Asymmetric Mandibular Prognathism. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237131"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.ijom.2021.08.008","article-title":"Three-dimensional condylar displacement and remodelling in patients wi th asymmetrical mandibular prognathism following bilateral sagittal sp lit osteotomy","volume":"51","author":"Abotaleb","year":"2022","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.ajodo.2017.08.024","article-title":"Three-dimensional computed tomography analysis of mandibular morphology in patients with facial asymmetry and mandibular retrognathism","volume":"153","author":"You","year":"2018","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"12319","DOI":"10.1038\/s41598-018-30270-7","article-title":"Linear and Volumetric Mandibular Asymmetries in Adult Patients With Di fferent Skeletal Classes and Vertical Patterns: A Cone-Beam Computed T omography Study","volume":"8","author":"Mendoza","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s40510-017-0197-6","article-title":"Comprehending the three-dimensional mandibular morphology of facial asymmetry patients with mandibular prognathism","volume":"18","author":"Kamata","year":"2017","journal-title":"Prog. Orthod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1016\/j.ijom.2017.02.1272","article-title":"Three-dimensional analysis of mandibular condyle position in patients with deviated mandibular prognathism","volume":"46","author":"Lee","year":"2017","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s40902-023-00393-7","article-title":"Skeletal structure of asymmetric mandibular prognathism and retrognathism","volume":"45","author":"Xi","year":"2023","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1016\/j.jds.2022.11.031","article-title":"Correlation between facial asymmetry of skeletal class III jaw relationship and morphology of the temporomandibular joint: A cone beam computed tomography study","volume":"18","author":"Chou","year":"2023","journal-title":"J. Dent. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.jds.2022.06.016","article-title":"Condylar and ramus volume in asymmetric and symmetric skeletal class III malocclusion: A cone-beam computed tomography study","volume":"18","author":"Chou","year":"2023","journal-title":"J. Dent. Sci."},{"key":"ref_27","first-page":"146","article-title":"Dynamic loading stimulates mandibular condyle remodeling","volume":"11","author":"Teixeira","year":"2022","journal-title":"J. World Fed. Orthod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/joor.13412","article-title":"Occlusal function and electromyographic activity of masticatory muscles in skeletal Class III patients with different patterns of mandibular asymmetry","volume":"50","author":"Chen","year":"2023","journal-title":"J. Oral. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1097\/SCS.0000000000008322","article-title":"The Effect of Orthognathic Surgery on Changes in Masticatory Muscle Volume in Patients With Facial Asymmetry","volume":"33","author":"Eo","year":"2022","journal-title":"J. Craniofacial Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.1007\/s00266-022-02958-9","article-title":"Fully Digitalized Workflow for One-Stage Mandibular Contouring and Orthognathic Surgery to Correct Severe Facial Asymmetry","volume":"46","author":"Raffaini","year":"2022","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.joms.2023.03.002","article-title":"Surgical Stability After Proximal Segment Angle Alteration in Patients With Class III Facial Asymmetry","volume":"81","author":"Lee","year":"2023","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Pachnicz, D., and Str\u00f3\u017cyk, P. (2021). A Biomechanical Analysis of Muscle Force Changes After Bilateral Sagittal Split Osteotomy. Front. Physiol., 12.","DOI":"10.3389\/fphys.2021.679644"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.ijom.2010.12.006","article-title":"Osseous healing after a sagittal splitting ramus osteotomy","volume":"40","author":"Hasegawa","year":"2011","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1080\/08869634.2022.2070333","article-title":"Changes in the condylar volume and skeletal relapse following orthognathic surgery in patients with dentofacial deformity: A retrospective study","volume":"43","author":"Takahara","year":"2025","journal-title":"Cranio"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e165","DOI":"10.1016\/j.jcms.2013.07.015","article-title":"Evaluation of postoperative stability after BSSRO to correct facial asymmetry depending on the amount of bone contact between the proximal and distal segment","volume":"42","author":"Yang","year":"2014","journal-title":"J. Cranio Maxillofac. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Petronis, Z., Janovskiene, A., Rokicki, J.P., and Razukevicius, D. (2024). Three-Dimensional Mandibular Condyle Remodeling Post-Orthognathic Surgery: A Systematic Review. Medicina, 60.","DOI":"10.3390\/medicina60101683"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ijom.2005.04.008","article-title":"Short- and long-term skeletal relapse after mandibular advancement surgery","volume":"35","author":"Eggensperger","year":"2006","journal-title":"Int. J. Oral. Maxillofac. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e461","DOI":"10.1016\/j.joms.2011.02.086","article-title":"Dental or skeletal relapse after sagittal split osteotomy advancement surgery? Long-term follow-up","volume":"69","author":"Moen","year":"2011","journal-title":"J. Oral. Maxillofac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4041\/kjod.2022.52.1.29","article-title":"Incidence and management of condylar resorption after orthognathic sur gery: An overview","volume":"52","author":"Barone","year":"2022","journal-title":"Korean J. Orthod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1097\/SCS.0000000000009382","article-title":"Condylar Resorption After Orthognathic Surgery: A Review of Risk Facto rs With a Proposed Algorithm of Treatment","volume":"34","author":"Othman","year":"2023","journal-title":"J. Craniofacial Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Li, Y.-T., Chen, Y.-A., Lin, C.-H., and Ko, E.W.-C. (2023). Preoperative Anatomical Variables Affecting the Outcome of Surgical Co rrection in Class III Face Asymmetry. Appl. Sci., 13.","DOI":"10.3390\/app13074502"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Attia, H. (2025). Stability and Relapse Challenges in Orthognathic Surgery: A Review. J. Microsc. Ultrastruct.","DOI":"10.4103\/jmau.jmau_148_24"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"101723","DOI":"10.1016\/j.cpsurg.2025.101723","article-title":"Management of secondary or residual deformities after orthognathic and OSA-related surgery: Case reports and review of literature","volume":"64","author":"Satin","year":"2025","journal-title":"Curr. Probl. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.coms.2019.09.003","article-title":"Comprehensive Post Orthognathic Surgery Orthodontics: Complications, Misconceptions, and Management","volume":"32","author":"Wolford","year":"2020","journal-title":"Oral. Maxillofac. Surg. Clin. N. Am."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s40902-024-00449-2","article-title":"Virtual surgical plan with custom surgical guide for orthognathic surgery: Systematic review and meta-analysis","volume":"46","author":"Lee","year":"2024","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"109189","DOI":"10.1016\/j.compbiomed.2024.109189","article-title":"Quantification of facial symmetry in orthognathic surgery: A novel approach integrating 3D contour maps and hyper-dimensional computing","volume":"183","author":"Ho","year":"2024","journal-title":"Comput. Biol. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"10959","DOI":"10.1038\/s41598-019-47477-x","article-title":"Similarity index for intuitive assessment of three-dimensional facial asymmetry","volume":"9","author":"Kwon","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_48","first-page":"e73477","article-title":"Accuracy of 3D Virtual Surgical Planning Compared to the Traditional Two-Dimensional Method in Orthognathic Surgery: A Literature Review","volume":"16","author":"Shalabi","year":"2024","journal-title":"Cureus"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s40902-024-00437-6","article-title":"Anatomic and functional masseter muscle adaptation following orthognathic surgery-MRI analysis in 3 years of follow-up","volume":"46","author":"Duarte","year":"2024","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Lo, L.J., Weng, J.L., Ho, C.T., and Lin, H.H. (2018). Three-dimensional region-based study on the relationship between soft and hard tissue changes after orthognathic surgery in patients with prognathism. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200589"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3855","DOI":"10.1007\/s00784-023-05004-3","article-title":"Long-term evaluation of masseter muscle activity, dimensions, and elasticity after orthognathic surgery in skeletal class III patients","volume":"27","author":"Muftuoglu","year":"2023","journal-title":"Clin. Oral. Investig."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.ajodo.2024.01.011","article-title":"Changes in masseter muscle morphology after surgical-orthodontic treatment in patients with skeletal Class III malocclusion with mandibular asymmetry: The automatic masseter muscle segmentation model","volume":"165","author":"Peng","year":"2024","journal-title":"Am. J. Orthod. Dentofac. Orthop."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/372\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T09:48:10Z","timestamp":1770976090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/2\/372"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":52,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["medicina62020372"],"URL":"https:\/\/doi.org\/10.3390\/medicina62020372","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}