Da. Cottrell et Lm. Wolford, ALTERED ORTHOGNATHIC SURGICAL SEQUENCING AND A MODIFIED APPROACH TO MODEL SURGERY, Journal of oral and maxillofacial surgery, 52(10), 1994, pp. 1010-1020
Advances in orthognathic surgical treatment planning and in techniques
for complex, simultaneous maxillary and mandibular repositioning have
resulted in improved surgical accuracy. In traditional surgical seque
ncing, maxillary surgery is performed first; the maxilla is set, with
or without an intermediate splint, using external reference points to
verify and/or determine appropriate movement. However, errors in model
surgery and intermediate splint fabrication can lead to surgical inac
curacy despite good surgical technique. In repositioning the maxilla f
irst, when thin bony walls are present, and/or in conjunction with lar
ge mandibular advancements, maxillary shifting may occur when maxillom
andibular fixation is applied. Soft tissue tension and surgical manipu
lation in this sequencing technique may result in a less desirable fun
ctional and esthetic outcome. This article presents an alternative to
surgical sequencing and a modification of model surgery techniques to
improve surgical accuracy, and thus predictability and stability of th
e results.