Objective: In surgical orthodontic treatment, a treatment plan is initially formulated. This plan is reviewed prior to surgery, and the surgical technique is often changed. This study aimed to provide insights into the surgical orthodontic treatment modification process. Methods: We included 501 patients who visited the Dental Treatment Center of Hokkaido University Hospital from April 2005 to March 2020 and underwent orthognathic surgery by March 2024. The survey items included whether the surgical technique had been changed, the details of any surgical changes, the discussion during the initial consultation, and the reasons for changing the surgical technique. The results were divided into three 5-year periods. Results: The surgical technique was changed in 138 cases (27.5%). The most common reasons for the change were jaw width, the amount of jaw movement, two occlusal planes, the amount of rotation or cant, and patient condition. Changes may also be attributed to the expanded scope of the surgical support at the time of initial planning and the introduction of insurance for anchor screws. The addition or omission of LeFort I was the most frequent surgical modification. Conclusions: In treating jaw deformities, the initial treatment should not be strictly adhered to without a preoperative review. Surgical planning should always be considered to reduce the patient's burden and optimize the stability of the occlusion.