This paper describes a modification of the combined bilatera sagittal split osteotomy and total subapical osteotomy procedure; a representative case treated with this apprach is presented. In addition, diagnostic and treatment planning considerations for the comprehensive surgical-orthodontic therapy of individuals presenting with differential sagittal discrepancy between the mandibular corpus and symphysis are discussed, along with limitations of diagnostic criteria commonly used in cephalometric appraisal of the facial soft tissue outline.