Objective:to review the most commonly used methods for the treatment of MTD and relate their outcomes on facial structures in three dimensions to east Asian esthetic preferences,and discuss the reasons behind the difference in their popularity in east Asian centers.Based on our experience and hospitals data,we discuss our indications and modifications required to achieve the most esthetic and functional outcomes.Methods:239 adult class Ⅲ patients with maxillary transverse deficiency who visited between April 2011 and November 2016 were enrolled in this retrospective study.The treatment plan included total(194 cases)or segmental(36 cases)maxillary Le fort osteotomy with premolar extraction in pre-surgical orthodontic by one step,and surgically assisted rapid maxillary expansion(SARME)combined with conventional orthognathic surgery(9 cases)by two steps.Clinical results were evaluated by medical photography,cast models,occlusion and cephalometric radiographic examination.Results:Outcomes and feedback information from patients showed that appropriate selection of relevant modalities could acquire a more harmonious profile look,with significant improvement of the maxillary arch-width and intermaxillary occlusion congruity.Conclusion:Adult Class Ⅲ east-Asian patients with MTD have unique combinations of facial and dental features.Detailed measurements and design should be considered comprehensively to achieve optimal results.