title: The surgery-first approach in orthognathic surgery: a retrospective study of 50 cases.
abstract: The surgery-first approach (SFA), without presurgical orthodontic treatment, has become favoured in the treatment of dentomaxillofacial deformities. This approach has been applied in our institution since 2012. The purpose of this study was to report our experience with the SFA for skeletal malocclusion. Fifty patients with skeletal malocclusions were enrolled in this study (11 bimaxillary protrusion, 27 skeletal class III malocclusion, and 12 facial asymmetry). After orthognathic-orthodontic consultation, suitability for SFA was determined and a treatment plan drawn up. Patients then underwent orthognathic surgery, which included Le Fort I maxillary osteotomy, bilateral sagittal split ramus osteotomy, subapical osteotomy, and genioplasty. Postoperative orthodontic treatment was started after a healing period of 2 weeks. The mean postoperative orthodontic treatment duration was 14.9 months, which is shorter than that of traditional joint orthognathic-orthodontic treatment. In the bimaxillary protrusion group, this was about 19 months, which was longer than for the other groups. After joint orthognathic-orthodontic treatment, a good facial profile and ideal occlusion were achieved. With the advantages of earlier improvements in patient facial aesthetics and dental function, the reduction in difficulty and treatment duration of orthodontic management, and increasing patient acceptance, SFA is regarded as an ideal and valuable alternative for this potentially complicated procedure.
authors.affiliation: Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
authors.forename: H B
authors.initials: HB
authors.lastname: Yu
authors.affiliation: Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
authors.forename: L X
authors.initials: LX
authors.lastname: Mao
authors.affiliation: Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
authors.forename: X D
authors.initials: XD
authors.lastname: Wang
authors.affiliation: Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
authors.forename: B
authors.initials: B
authors.lastname: Fang
authors.affiliation: Department of Oral and Craniomaxillofacial Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China. Electronic address: maxillofacsurg@163.com.
authors.forename: S G
authors.initials: SG
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005146:Facial Asymmetry / Q000628:therapy*; D005260:Female; D063172:Genioplasty; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000628:therapy*; D056948:Orthognathic Surgical Procedures; D010027:Osteotomy; D010347:Patient Care Planning; D011182:Postoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: dentomaxillofacial deformity; malocclusion; orthognathic surgery; surgery-first