PurposeTo retrospectively compare the high-angled sagittal split osteotomy (HOO) and the bilateral sagittal split osteotomy (BSSO) for the correction of skeletal dysgnathias regarding intra- and postoperative complications.MethodsThe electronic medical records of all patients treated with an orthognathic surgery at the Department for Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Germany, between the years 2009 and 2019 were retrospectively reviewed.ResultsTwo hundred ninety-one patients were included. The overall complication rates were 19.78% (BSSO) compared to 12.5% (HOO) (p= 0.14). Significant differences were found regarding the operation time (HOO < BSSO,p= 0.02), material failure (HOO > BSSO,p= 0.04), and early recurrence requiring revision surgery (HOO < BSSO,p= 0.002). The use of a ramus plate significantly reduced the risk of plate failure (2.8% < 13.6%,p= 0.05). More bad splits (p= 0.08) and early sensory disorders (p= 0.07) occurred in the BSSO group.ConclusionThe HOO presents a possible alternative to the BSSO since newly developed osteosynthesis material significantly reduces the risk of material failure. The BSSO is accompanied by higher risks of developing complications like a bad split and sensory disorders but, however, remains the standard for large anterior–posterior transpositions of the mandible.