title: Skeleton first in surgical treatment of facial disharmony.
abstract: OBJECTIVE
  The aim of this study was to correct facial disharmony with or without occlusal dysfunction.
  
  
  METHODS
  Based on computed tomography and presurgical design, restoration of normal skeleton relationship is a priority for selected facial deformities. Combination of different osteotomies for facial skeleton was chosen in 1-stage operation such as orthognathic surgery, zygomatic reduction, and mandibular angle reduction. Supplementary surgeries was considered in some cases as substitute implantation or autologous fat graft.
  
  
  RESULTS
  All the 50 patients (hemifacial microsomia, Romberg syndrome, mandibular condyle hyperplasia, secondary cleft palate, and Crouzon syndrome) received surgeries, and their facial appearance improved significantly. Yearly follow-up shows that the symmetry and balance of the facial proportion approach normal, whereas most of their occlusal relationship has been significantly improved after the first stage of surgery.
  
  
  CONCLUSIONS
  For most facial disharmony with or without occlusal dysfunction, skeleton-first surgery is a feasible strategy.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Huashan Hospital, Fudan University School of Medicine, Shanghai, China.
authors.forename: Junyi
authors.initials: J
authors.lastname: Yang
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Lei
authors.forename: Yingzhi
authors.initials: Y
authors.lastname: Wu
authors.forename: Jiawen
authors.initials: J
authors.lastname: Lu
authors.forename: Ronghu
authors.initials: R
authors.lastname: Ke
authors.forename: Qiangshan
authors.initials: Q
authors.lastname: Yu
authors.forename: Xiongzheng
authors.initials: X
authors.lastname: Mu
mesh_terms: D000293:Adolescent; D000328:Adult; D005150:Facial Hemiatrophy / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D015361:Rhytidoplasty / Q000379:methods*; D055815:Young Adult