Purpose: This retrospective study evaluated the changes in hyoid bone and tongue positions as well as oral cavity volume after mandibular setback by BSSRO. Materials and Methods: 18 Koreans who underwent BSSRO to correct mandibular prognathism were studied. Lateral cephalograms were taken and traced preoperatively (T0), immediately (T1) and approximately 6 months postoperatively (T2). Submentovertex radiograghs were taken and traced before surgery (T0) and about 6 months after surgery (T2). The area and volume of oral cavity, the vertical and horizontal dimensions of the hyoid bone and tongue dorsum were measured. Results: Mandibular setback surgery resulted in a significant reduction of lower oral cavity volume. The hyoid bone displaced posteroinferiorly immediately after surgery, and it tended to return to its original vertical position at 6 month after mandibular setback by BSSRO. The retropalatal space around tongue was maintained and the retrolingual space around tongue was reduced immediately postoperatively. The readaptation of tongue was not evident for that the follow up period was not long enough. No significant statistical correlations between the amounts of mandibular setback and the changes of oral cavity volume were observed. Conclusion: Mandibular setback surgery resulted in a significant reduction of lower oral cavity volume, which was most likely attributable to the posterior movement of the mandible. More subjects and long-term observations should be performed to assess the changes of oropharyngeal configuration following mandibular setback surgery.