Background: This study describes the long-term skeletal outcomes of occlusal plane rotational orthognathic surgery, shifting from traditional maxillomandibular complex advancement or setback by tailoring the direction and magnitude of rotation based on clinical and occlusal characteristics.

Methods: Patients undergoing maxillomandibular complex rotation by means of Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were divided into 4 groups reflecting distinct occlusal and clinical characteristics: group A (class III malocclusion, posterior impaction with clockwise rotation); group B (cleft-related class III malocclusion, anterior lengthening with clockwise rotation); group C (class II malocclusion with sleep apnea, posterior lengthening with counterclockwise rotation); and group D (class II malocclusion with vertical maxillary excess, anterior impaction with counterclockwise rotation). Cephalometric landmarks were analyzed preoperatively, immediately postoperatively, and 3 years postoperatively. Postsurgical relapse was categorized as clinically insignificant (<2 mm/<2 degrees), potentially significant (2 to 4 mm/2 to 4 degrees), and highly significant (>4 mm/>4 degrees).

Results: The study included 76 patients (group A, 29 patients; group B, 22 patients; group C, 15 patients; and group D, 10 patients), with a mean evaluation period of 5.03 days immediately postoperatively and 36.5 months at 3 years postoperatively. Group B exhibited significant horizontal and vertical relapse at the cephalometric A point, with 54.5% showing potentially significant horizontal relapse and 45.5% showing vertical relapse. At the cephalometric B point, 3.4% of group A, 31.8% of group B, and 13.3% of group C demonstrated potentially significant vertical changes.

Conclusion: Occlusal plane rotational orthognathic surgery provides reliable skeletal stability when tailored to distinct clinical contexts, offering a versatile approach for aesthetic and functional correction.