Background: Modern orthognathic surgery (OGS) was established on the basis
of contributions from multidisciplinary centers worldwide. This study reports the
history and evolution of OGS at the Chang Gung Craniofacial Center (CGCC)
and identifies the lessons learned from 35 years of experience.
Methods: The total number ofOGS proceduresmanaged by the CGCCmultidisciplinary
team between 1981 and 2016 was determined. The database of the senior
author (Y.-R.C.) was reviewed for consecutive OGS procedures performed between
2003 and 2016. A literature review was also performed to retrieve the contributions
from the total CGCC team.
Results: The 35 years of experience at a single center and 13-year experience of a
single surgeon corresponded to 8073 and 2883 OGS procedures, respectively.
Moreover, 53 peer-reviewed articles were reviewed. Teamwork (plastic surgeons,
orthodontists, and anesthetists) ensured an optimal balance between occlusion functional
and facial aesthetic outcomes, with patient safety ensured and a minimum of
OGS-related complications. Progression from the conventional orthodontics-first
approach to the surgery-first OGS approach decreased the overall treatment time.
Transition from 1-jaw to 2-jaw surgery enabled more consistent aesthetic outcomes
to be achieved. Conversion from the 2-splint to the single-splint technique enabled
development of a more precise tridimensional simulation plan and surgical execution,
including in challenging scenarios such as malocclusion associated with facial
asymmetry. Clockwise pitch rotation of the maxillomandibular complex has been
designed for facial aesthetic purposes in class III malocclusion, whereas counterclockwise
pitch rotation of the maxillomandibular complex improves airway function
in those with sleep apnea.
Conclusions: The lessons learned from experience and outcome-based articles
reveal that OGS has successfully evolved at the CGCC, with a balance being
achieved between functional and aesthetic outcomes and effective decreases in
the burden of care (ie, morbidity, complications, and treatment time).

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