• The Journal of the Korean dental association
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• v.50 no.11
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• pp.682-688
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• 2012

Surgery first approach in orthognathic surgery is to proceed the orthognathic surgery without preoperative orthodontic treatment. This approach has many advantages, which include a shorter total treatment period, a high level of patient satisfaction due to immediate post-surgical facial improvement, easy postoperative orthodontic treatment due to early normalization of skeletal muscle, and the rapid tooth movement reflecting the regional accelerated phenomenon. However instability due to transient occlusal interference after surgery make worse of long-term skeletal stability. Especially increasing of vertical occlusion caused by interference of interbicupid and molar happen postsurgical skeletal change. Until now, there is no common consensus about treatment protocol of surgery first approach in orthognathic surgery. The purpose of this paper is to introduce our treatment protocol of the surgery first approach and to evaluate indication and limitation with case analysis.

• The Journal of the Korean dental association
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• v.56 no.11
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• pp.622-630
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• 2018

For successful surgery-first approach, accurate prediction of skeletal and dental changes following orthognathic surgery is essential. With recent development of digital technology using computer-aided design/computer-aided manufacturing (CAD/CAM) technology, attempts to provide more predictable orthodontic/orthognathic treatment have been made through 3D virtual surgery and digital tooth setup. A clinical protocol for the surgery-first orthognathic approach using virtual surgery is proposed. A case of skeletal Class III patient with facial asymmetry treated by the surgery-first approach using digital setup and virtual surgery is presented. Advantages and limitations of applying CAD/CAM technology to orthognathic surgery are discussed.

• Archives of Plastic Surgery
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• v.48 no.2
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• pp.199-207
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• 2021

Traditional orthognathic surgery has long been performed after presurgical orthodontic treatment. Despite some concerns, the surgery-first orthognathic approach (SFOA) or surgery-first approach (SFA) without presurgical orthodontic treatment has gradually gained popularity. In recent years, several articles dealing with the concepts of the SFA have been published worldwide. However, the SFA has not yet been standardized, and many surgeons use slightly different protocols and concepts. This review article discusses the beginning and evolution of the SFA and its current concepts, including some opinions based on the authors' clinical experiences over the last 15 years. According to recent investigations, the SFA could be applied effectively in several situations including class III malocclusion, class II malocclusion, and facial asymmetry. However, debate on the SFA continues and many issues remain to be resolved. This review article addresses the current issues regarding the SFOA, including its advantages and disadvantages, as well as its indications and contraindications. The authors summarize various aspects of the SFA and expect that this review article will help surgeons and orthodontists better understand the current status of the SFA.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.23.1-23.10
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• 2019

The choice of surgical technique in orthognathic surgery is based primarily on the surgical treatment objectives (STO), which is a fundamental component of the orthognathic treatment process. In the conventional orthodontics-first approach, presurgical planning can be performed twice, during the preorthodontic (initial STO) and presurgical phases (final STO). Recently, a surgery-first orthognathic approach (SFA) without presurgical orthodontic treatment has been introduced and combined initial and final STO at the same time. In contrast to the conventional surgical-orthodontic treatment protocol that includes preoperative orthodontics for dental decompensations to maximize stable postoperative occlusion, the SFA potentially shortens the treatment period and minimizes esthetic concerns during the decompensation period because skeletal problems are corrected from the beginning. The indications for the SFA have been proposed in the literature, but no consensus exists. Moreover, because dental occlusion of the pre-orthodontic arches cannot be used as a guide for establishing the surgical treatment plan, there are fundamental limitations in accurate prediction of postsurgical results in the SFA. Recently, the concepts of postsurgical orthodontic treatment are continuously changing and evolving to overcome this inherent limitation of the SFA. The elimination of presurgical orthodontics can change the paradigm of orthognathic surgery but still requires cautious case selection and thorough discussion and collaboration between orthodontists and surgeons regarding the goals and postoperative management of the orthognathic procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.1
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• pp.23-28
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• 2017

Objectives: The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). Materials and Methods: The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). Results: The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was $2.23{\pm}0.92mm$ (P<0.01) forward movement and $-0.87{\pm}0.57mm$ (non-significant, NS) upward movement on the basis of point B and $2.54{\pm}1.37mm$ (P<0.01) forward movement and $-1.18{\pm}0.79mm$ (NS) upward movement on the basis of the pogonion (Pog) point. The relapse amount of the mandible in the surgery-first orthognathic approach group from T1 to T2 was $3.49{\pm}1.71mm$ (P<0.01) forward movement and $-1.78{\pm}0.81mm$ (P<0.01) upward movement on the basis of the point B and $4.11{\pm}1.93mm$ (P<0.01) forward movement and $-2.40{\pm}0.98mm$ (P<0.01) upward movement on the basis of the Pog. Conclusion: The greater horizontal and vertical relapse may appear because of counter-clockwise rotation of the mandible in surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.10.1-10.8
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• 2019

The "surgery-first" approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.

• Archives of Plastic Surgery
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• v.50 no.3
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• pp.254-263
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• 2023

Background The three-dimensional (3D) evaluation of skeletal stability after orthognathic surgery is a time-consuming and complex procedure. The complexity increases further when evaluating the surgery-first orthognathic approach (SFOA). Herein, we propose and validate a simple time-saving method of 3D analysis using a single software, demonstrating high accuracy and repeatability. Methods This retrospective cohort study included 12 patients with skeletal class 3 malocclusion who underwent bimaxillary surgery without any presurgical orthodontics. Computed tomography (CT)/cone-beam CT images of each patient were obtained at three different time points (preoperation [T0], immediately postoperation [T1], and 1 year after surgery [T2]) and reconstructed into 3D images. After automatic surface-based alignment of the three models based on the anterior cranial base, five easily located anatomical landmarks were defined to each model. A set of angular and linear measurements were automatically calculated and used to define the amount of movement (T1-T0) and the amount of relapse (T2-T1). To evaluate the reproducibility, two independent observers processed all the cases, One of them repeated the steps after 2 weeks to assess intraobserver variability. Intraclass correlation coefficients (ICCs) were calculated at a 95% confidence interval. Time required for evaluating each case was recorded. Results Both the intra- and interobserver variability showed high ICC values (more than 0.95) with low measurement variations (mean linear variations: 0.18 mm; mean angular variations: 0.25 degree). Time needed for the evaluation process ranged from 3 to 5 minutes. Conclusion This approach is time-saving, semiautomatic, and easy to learn and can be used to effectively evaluate stability after SFOA.

• Archives of Plastic Surgery
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• v.47 no.5
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• pp.404-410
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• 2020

Background Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery. Methods Ten Jehovah's Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used. Results The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications. Conclusions This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah's Witnesses can be applied to the management of all patients who refuse blood transfusions.

• The Journal of the Korean dental association
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• v.55 no.4
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• pp.296-302
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• 2017

The traditional orthognathic surgery treatment consists of three steps: preoperative orthodontic treatment, orthognathic surgery, and postoperative orthodontic treatment, and the average treatment period is usually two years. Also, patients with Class III malocclusion should spend more time getting their facial features worse during the decompensation process. However, most of the patients who want orthognathic surgery visit the chief complaints of appearance improvement, and resolve this address as soon as possible. The concept of $^{\circ}{\AE}$Surgery - First 'does not cause a facial imbalance caused by decompensation for the pre - operative correction period, and the patient can obtain an improved facial profile immediately after the operation. In addition, the correction period is shortened by Regional Acceleratory Phenomenon (RAP) after surgery. However, it is not applicable to all patients. Patients with severe crowding, severe curve of spee or reverse curve of spee, severe transverse discrepancy of the maxilla and mandibular arch, and severe incisal angles are less likely to apply the technique. Although it is not yet possible to apply this technique to all patients, it has many advantages over the conventional method. Especially, the patients' preference is increasing due to the rapid appearance improvement and the shortening of the total treatment period.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.2
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• pp.61-62
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• 2017