THE EVOLUTION OF ORTHOGNATHIC SURGERY: FROM HISTORICAL CHALLENGES TO MODERN INNOVATIONS

Abstract

Orthognathic surgery has undergone a profound transformation from early procedures aimed primarily at correcting mandibular deformities to a sophisticated multidisciplinary approach focused on functional, skeletal, and aesthetic rehabilitation. This review traces the major stages in the historical development of orthognathic surgery and examines the key surgical innovations that shaped contemporary clinical practice. Early mandibular procedures were characterized by limited bony contact, extraoral access, inadequate occlusal control, postoperative infection, and a high risk of relapse. Subsequent modifications progressively addressed these limitations through improved osteotomy design, preservation of neurovascular structures, orthodontic coordination, and enhanced stabilization. A major milestone was the development of the sagittal split osteotomy by Hugo Obwegeser and its subsequent modifications by Dal Pont, Hunsuck, and Epker, which established a more predictable and biologically conservative approach to mandibular repositioning. In parallel, advances in maxillary surgery, particularly complete Le Fort I mobilization and down-fracture, enabled controlled three-dimensional repositioning of the maxilla. Experimental studies further clarified the importance of vascular preservation for maxillary viability and bone healing. The development of genioplasty and bimaxillary surgery expanded the scope of skeletal and facial correction, while the introduction of rigid internal fixation improved postoperative stability and reduced the need for prolonged intermaxillary fixation. Overall, the historical evolution of orthognathic surgery reflects a gradual transition from isolated skeletal resection toward biologically informed, functionally controlled, and aesthetically oriented reconstruction. The integration of surgical innovation, orthodontic planning, vascular preservation, bone healing principles, and rigid fixation established the foundation of modern orthognathic surgery.