A surgery-first approach using single-jaw rotational mandibular setback in low-angle mandibular prognathism

For the treatment of low-angle mandibular prognathism, rotational mandibular setback surgery is usually performed with Le Fort I maxillary osteotomy to rotate the maxillomandibular complex simultaneously. However, this maxillary surgery can be replaced with the orthodontic intrusion of maxillary posterior teeth. Single-jaw rotational mandibular setback surgery can be done with a surgery-first approach by planning orthodontic rotation of the maxillary occlusal plane with the simulation of the postsurgical forward mandibular rotation. This case report describes this approach applied to a 19-year-old female patient with low-angle mandibular prognathism but without maxillary deficiency. A Class II open bite was formed by the rotational setback surgery. During postsurgical orthodontic treatment, the maxillary total arch was distalized with maxillary molar intrusion using palatal mini-implants and lever. This case report demonstrates that orthodontic rotation of the maxillary occlusal plane and simulation of mandibular rotation can replace maxillary surgery and enable single-jaw rotational mandibular setback surgery with a surgery-first approach. •Single-jaw rotational mandibular setback surgery can be done with a surgery-first approach.•Orthodontic rotation of the maxillary occlusal plane can replace maxillary posterior impaction surgery.•Maxillary occlusal plane can be rotated orthodontically after the surgery is done first.•The forward rotation of the mandible in harmony with the postsurgical intrusion of maxillary posterior teeth should be expected and Class II open bite should be made right after surgery.•Double-jaw-surgery-like effect can be achieved by single-jaw rotational mandibular setback surgery, even with surgery-first approach.