This case report describes a patient who presented with a severe class 2 skeletal discrepancy together with a Class II malocclusion and a large anterior open bite. The malocclusion and skeletal discrepancy were managed with a combination of orthodontic and orthognathic treatment. The orthognathic surgery was undertaken following orthodontic decompensation using sectional mechanics to allow a segmental bimaxillary osteotomy and genioplasty to be performed. Although the discrepancy was severe using this combination of treatment, a successful outcome, both facially and occlusally, was achieved.