Abstract <p>The aim of this retrospective study is to investigate the optimal airway management of orthognathic surgery anesthesia for correcting jaw deformity secondary to cleft lip and palate (CLP) by comparing the differences between nasal and submandibular intubation. Preoperative (T0), 1 week postoperatively (T1), and 6 months postoperatively (T2) CT scans and vital signs after oral intubation (S0), before reconnection of the submandibular tracheal catheter (S1), and after reconnection (S2) were collected from 54 patients who received nasal intubation (Group I) and submandibular intubation (Group II). The results were evaluated using 3D reconstruction and analysis in Mimics. During the follow-up, all patients demonstrated satisfactory facial shape and stable occlusion and no significant complications were observed. In Group II, maxillary operation duration and blood loss were significantly reduced (<i>P</i> &lt; 0.001), and nasal septum deviation was distinctly improved (<i>P</i> &lt; 0.001). Both groups exhibited increased nasal alar width, but Group I particularly females showed greater changes (<i>P</i> &lt; 0.05). Only 2 patients (6%) in Group II developed hypertrophic scars 6 months postoperatively. This study demonstrates that submandibular intubation anesthesia represents a straightforward, safe and less complicated technique in orthognathic surgery for CLP patients. Nevertheless, this method should be carefully chosen for patients with scar constitution.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>