Nelson describes 4 cases of alternative approaches to conventional orthognathic surgery processes.

1. Facial asymmetry due to condylar hypoplasia:

a. Genioplasty Propella

i. 2 cuts, 1 horizontal, 1 angular and rotate the middle component

2. Class 2 due to retrognathic mandible

a. Corrected by 4 stages

i. Genioplasty

ii. Start anterior subapical osteotomy

iii. BSSO advancement

iv. Complete subapical and inferior repositioning = prevent lateral openbites

3. Class 3 due to maxillary hypoplasia AP and vertical.

a. 3 Stage process with segmental maxillary osteotomy

i. Maxillary advancement

ii. Extraction of U4s, anterior subapical osteotomy, retracting and rotation to surgically decompensate

iii. Mandibular set back

4. Class 2 due to maxilla hyperplasia

a. Maxillary osteotomy 2 part: horse shoe shaped osteotomy

i. Separating dental and skeletal components

ii. Allow set back of dentoalveolar component and upward positioning of the maxilla