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Introduction: The aim of the present study was to investigate retrospectively the long-term stability of the mandibular after counterclockwise surgical advancement with a bilateral sagittal split osteotomy with or without a Le Fort I osteotomy or genioplasty.Materials and methods: Twenty-eight patients with a mandibular deficiency with a mandibular plane angle (MPA) of more than 35 degrees (high angle) were included.The patients 26 females and 2 males had a mean age at surgery of 29.7 years.All were treated by a bilateral sagittal split osteotomy (BSSO).Seven patients as a single jaw procedure and 21 patients in combination with a Le Fort I osteotomy and genioplasty.Clinical and radiological data were taken preoperatively (T1), immediately until 6 weeks postoperatively (T2), 1 year until 3 years postoperatively (T3), and long term with an average time of 20 years postoperative (T4).Cephalometric values of the MPA were recorded and compared.