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Mandibular Retrognathia

 A condition we routinely treat, retrognathia is highly correctable with outcomes that restore projection, function, and facial balance.

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What Is Mandibular Retrognathia

Understanding Mandibular Retrognathia

Treatment often involves Orthognathic surgery to advance the lower jaw and, when necessary, reposition the upper jaw to correct the underlying skeletal imbalance, restoring proper function, improving facial proportions, and relieving strain on the jaw joints and surrounding structures.

Clinical presentation of mandibular retrognathia, with statistics.

Clinical Presentation

Close-up of a smiling woman with red hair and clear skin with retrognathia.
Frontal View

Frontal Analysis

In mandibular retrognathia, the lower jaw is positioned behind the upper jaw, often affecting the balance of the lower face. The chin may appear less prominent, with reduced definition in the lower third.

Key Assessments:

Retruded lower jaw position
Reduced chin projection
Lower facial deficiency
CR-CO discrepancy
Clinical presentation of mandibular retrognathia, profile view.
Side View

Profile Analysis

From the side, mandibular retrognathia is characterized by a retruded lower jaw, creating a convex facial profile. The chin appears recessed relative to the upper jaw and midface.

Key Assessments:

Retruded mandible
Convex facial profile
Recessed chin position
Upper-lower jaw imbalance
Clinical presentation of mandibular retrognathia, occlusal view.
Bite View

Occlusal Relationship

Mandibular retrognathia commonly presents with a bite relationship reflecting a retruded lower jaw, most often a Class II occlusion.

Key Assessments:

Class II occlusion pattern
Increased overjet
Upper teeth ahead of lower
Dental arch misalignment

Mandibular Retrognathia

Common Functional Issues

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Eating

Reduced lower jaw projection can make biting into foods difficult and may shift chewing function toward the back teeth.

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Speech

Speech clarity may be affected, particularly with sounds requiring precise tongue-to-tooth contact.

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TMJ

A retruded jaw position can strain the joint and surrounding muscles, sometimes leading to pain, clicking, or limited opening.

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Mouth Breathing

A smaller lower jaw can reduce airway space, increasing the likelihood of mouth breathing, especially during sleep.

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Nasal Congestion

Restricted nasal airway dimensions may contribute to inefficient nasal breathing and potential sleep-disordered breathing.

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Psychosocial Effects

A recessed chin and profile can affect facial harmony, sometimes leading to concerns about appearance or confidence.

Before & After Gallery

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Mandibular Retrognathia

Jaw Surgery Procedures

Orthognathic surgery corrects retrognathia by advancing an underdeveloped lower jaw and, when needed, repositioning the upper jaw to restore proper bite and facial balance. Most commonly, double jaw surgery is performed, combining BSSO (mandibular advancement) and Le Fort I osteotomy to create a more balanced, harmonious result.

BSSO

BSSO Result Illustration

BILATERAL SAGITTAL SPLIT OSTEOTOMY

Used to advance the lower jaw forward, restoring projection and improving occlusion.

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Le Fort I

Le Fort I Osteotomy Result Illustration

LE FORT I OSTEOTOMY

The upper jaw may be repositioned or rotated to optimize the occlusal plane and complement mandibular advancement.

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Double Jaw

Double Jaw Surgery Result Illustration

DOUBLE JAW SURGERY

Combined surgery allows coordinated advancement and counterclockwise rotation to improve both airway and facial balance.

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Life-Changing Benefits

Advancing a recessed lower jaw improves bite function, airway health, and facial balance.

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Improved bite and function
Enhanced airway and breathing
Reduced TMJ discomfort
Improved facial projection
Better speech articulation
Increased confidence

Surgical Management of Mandibular Retrognathia

Lower Jaw

Bilateral sagittal split osteotomy corrects lower jaw deficiency by separating the mandible on both sides behind the last molar, allowing the tooth-bearing segment to be advanced forward into proper alignment. This single-jaw procedure restores a balanced bite, improves chin projection, and achieves natural facial proportions. The jaw is secured with titanium plates and screws, improving chewing, speech, and airway function. Each case is planned with advanced imaging and surgical simulation.

Both Jaws

When retrognathia is severe or accompanied by additional skeletal discrepancies, double jaw surgery is recommended. A bilateral sagittal split osteotomy is combined with a Le Fort I osteotomy, advancing the lower jaw while simultaneously repositioning the upper jaw to optimize the bite and facial profile. When indicated, a counterclockwise rotation of the mandible further enhances chin projection and adjusts the occlusal plane. Both jaws are secured with titanium plates and screws, improving chewing, speech, breathing, and facial balance.

Presurgical Considerations

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Growth Completion

Key Assessment Points:

Mandibular growth Plateaus
Bite correction no longer improving
Growth spurt nearing completion
Skeletal age confirmed
Girl wearing braces eyeglasses.

Orthodontic Planning

Key Assessment Points:

Incisor decompensation achieved
Excess overjet maintained
Arches leveled & aligned
Arches coordinated
Clinical jaw evaluation with a patient.

TMJ & Airway Evaluation

Key Assessment Points:

TMJ function evaluation
MRI imaging if indicated
CR-CO discrepancy documented
Condylar resorption assessed

Timeline for Mandibular Retrognathia

Month 0

Initial Consultation

Comprehensive history, clinical evaluation, 3D scans, X-rays, photographs, and impressions to assess jaw position and bite.

2–4 weeks after initial consultation

Treatment Planning Visit

Once your records are reviewed and the doctor has coordinated with your orthodontist, you’ll return either in person or via telemedicine to review your treatment plan, see prediction images, and go over the steps and timeline ahead.

6–12 months

Orthodontic Preparation (if necessary)

Braces or aligners gradually guide the teeth into proper positions to prepare the jaws for surgical
correction. In select cases, a surgery-first approach may be possible.

3-6 weeks prior to surgery

Final Surgical Planning

Virtual surgical planning determines precise bone movements for optimal symmetry, stability,
and facial balance.

2–4 weeks prior to surgery

Pre-Op Medical Clearance

Medical exams, lab testing, and final instructions ensure the body is fully prepared for surgery.

Typically a one-night hospital stay

Surgery Day

Corrective jaw surgery is performed to reposition the jaws, improve bite function, and enhance facial balance.

3–9 months after surgery

Post-Surgical Orthodontics

Final orthodontic treatment fine-tunes tooth position and bite, optimizing aesthetics, function, and long-term stability.

Experience Matters

“We personally plan your care, perform your surgery, and guide your recovery. No residents, no fellows, no handoffs.“

Choosing the right surgical team matters. You should feel informed, comfortable, and confident in every step of the process. At our practice, your care is provided by one of the most highly trained and experienced jaw surgery teams in the country.

When you come to our office, you meet directly with your surgeons. We are the ones who plan your treatment, perform your surgery, see you after surgery, and remain personally available to you throughout your recovery. Unlike larger institutions, your care is not delegated to residents, fellows, or doctors in training. Every critical aspect of your treatment is handled by your surgeons.

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Founding Members of the American Society of Orthognathic Surgery

What Our Patients Are Saying

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★★★★★

Dr Lee and the team at Northeast Facial are incredible. I was very nervous about my procedure but Dr Lee walked me through it step by step, never once making me feel rushed. Silvanna at the front desk went above and beyond to help me schedule an appointment that worked for me. I would highly recommend NEFOSS!

Stephanie Brown

★★★★★

“I had double jaw surgery done with Dr. Jacob in June 2021. I am extremely happy with my results. No more jaw pain and chewing problems. I also feel much more confident with my new smile. The surgery was definitely well worth it, thanks to Dr. Jacob and his team!”

Amelia Chen

★★★★★

“I would definitely recommend Dr. Jacob and his team at NEFOSS! Dr. Jacob and the team of doctors are very knowledgeable about all aspects of the TMJ process. They are such a nice group of doctors! The office staff is also very helpful and very friendly.”

Tiffany Puopolo

Frequently Asked Questions

Here are some common questions about Mandibular Retrognathia and the surgical options available.

Clinical jaw evaluation with a patient.
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