Surgical superior repositioning of the maxilla: what to do with the mandible?

During superior repositioning of the maxilla (SRM), the mandible autorotates forward and upward at pogonion, with the condyle as the center of rotation. Thus, in each instance when planning surgical superior repositioning of the maxilla one must decide, on the basis of esthetics and cephalometric prediction criteria, the magnitude of autorotation and the contribution of this rotation toward the desired occlusal and esthetic result. In many instances the maxilla can be moved somewhat posteriorly or anteriorly, and thus simultaneous mandibular surgery is not required to achieve the desired result. In some cases, however, simultaneous mandibular advancement or set-back is required to achieve the desired occlusal and esthetic result. This article discusses the specifics of making the decision regarding what to do with the mandible when superiorly repositioning the maxilla.