Long-term outcomes of bimaxillary surgery for treatment of asymmetric skeletal class III deformity using surgery-first approach

Objectives: Although several studies have reported the advantages of the surgery-first approach for orthognathic correction of Class III deformity, there are few reports of the success of this approach for patients with facial asymmetry. Therefore, the purpose of this study was to evaluate the outcome of bimaxillary surgery for asymmetric skeletal Class III deformity using a surgery-first approach. Materials and methods: Sixty-five patients who consecutively underwent at least a combined Le Fort I and a bilateral sagittal split osteotomy for asymmetric skeletal Class III deformity were identified in the authors’ patient database. Standardized frontal photographs were used to measure the change in midface, intercommissural line, chin from midface, and chin deviation angles as well as upper, middle, and lower contour deviation angles. The facial midline symmetry index, facial contour symmetry index, and overall facial symmetry index were also calculated. Self-reported questionnaires regarding overall appearance and satisfaction with facial areas were administered at least 1 year post-surgery. Results: Forty-six patients had genioplasty. There was a statistically significant improvement in the deviation angles measured and the facial midline, facial contour, and overall facial symmetry index. Self-reported questionnaires, completed at least 1 year post-surgery, showed that patient satisfaction was high. Conclusions: These findings demonstrate that the surgical-orthodontic treatment with surgery-first approach can successfully maintain or improve facial symmetry. Clinical relevance: The surgery-first approach for improving facial asymmetry using the guidelines described for setups of the models is a feasible alternative to the classic orthodontic-first approach for bimaxillary orthognathic surgery.