title: Mandible-first sequence in bimaxillary orthognathic surgery: a systematic review.
abstract: The sequencing of bimaxillary orthognathic surgery remains controversial, although the traditional maxilla-first approach is performed routinely. The goal of this study was to present a systematic review of the mandible-first sequence in bimaxillary orthognathic surgery, to provide data that may assist in the decision as to which jaw should undergo osteotomy first in bimaxillary orthognathic surgery cases. A literature search was conducted for articles published in the English language, reporting the use of the altered sequence for bimaxillary orthognathic surgery (mandible-first), using the following descriptors: 'orthognathic' and 'double-jaw', 'orthognathic' and 'two-jaw', 'orthognathic' and 'mandible-first', 'orthognathic' and 'bimaxillary'. Eight hundred eighty-seven abstracts were initially identified and were evaluated for inclusion according to the proposed inclusion criteria. After evaluation of these abstracts and relevant references, six publications met the criteria for consideration. Performing mandible-first surgery in bimaxillary orthognathic cases dates back to the 1970s; however the decision regarding the jaw to be operated on first seems to rely on accurate preoperative planning based upon the surgeon's experience and preference. While there appear to be significant theoretical advantages to support the use of the altered orthognathic sequence (mandible-first), future prospective studies on its reliability, accuracy, and short- and long-term outcomes are required.
authors.affiliation: Master of Science Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá - UNIC, Cuiabá, Brazil; Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo - USP, São Paulo, Brazil; Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: alex80@terra.com.br.
authors.forename: A M
authors.initials: AM
authors.lastname: Borba
authors.affiliation: Master of Science Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá - UNIC, Cuiabá, Brazil.
authors.forename: A H
authors.initials: AH
authors.lastname: Borges
authors.affiliation: Master of Science Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá - UNIC, Cuiabá, Brazil.
authors.forename: P S
authors.initials: PS
authors.lastname: Cé
authors.affiliation: Master of Science Program on Orthodontics, São Leopoldo Mandic Research Center, Campinas, Brazil.
authors.forename: B A
authors.initials: BA
authors.lastname: Venturi
authors.affiliation: Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo - USP, São Paulo, Brazil.
authors.forename: M G
authors.initials: MG
authors.lastname: Naclério-Homem
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: M
authors.initials: M
authors.lastname: Miloro
mesh_terms: D006801:Humans; D008334:Mandible / Q000601:surgery*; D008437:Maxilla / Q000601:surgery*; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D010027:Osteotomy
keywords: altered sequence; bimaxillary; double-jaw; orthognathic surgery; two-jaw