Comparing maxillary surgical accuracy in mandible-first and maxilla-first sequencing for bimaxillary orthognathic surgery: a retrospective study in facial asymmetry patients
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Abstract
Objective: This study aimed to compare the surgical accuracy of the maxilla between the maxilla- and mandible-first sequence bimaxillary orthognathic surgery for facial asymmetry patients
Materials and Methods: A retrospective cohort study was conducted on forty patients with skeletal asymmetry of the jaw(s) who underwent bimaxillary orthognathic surgery. The patients were evenly divided into the maxilla-first and mandible-first sequence groups. Surgical accuracy of the maxilla was determined by comparing the maxillary position in immediate postoperative cone beam computed tomography images to the simulated surgical plans. Three linear measurements using seven reference points and three angular measurements (roll, pitch, and yaw) were performed. Statistical analysis, including the independent samples t-test and the Mann-Whitney U test, was used to compare the means and medians between the two groups. The level of significance was set at p < 0.05.
Results: The accuracy of the maxilla, as measured by linear measurements, showed no significant differences between the two groups (p = 0.05–0.92). On the other hand, significant differences were observed in the roll and yaw rotations, with p-values of 0.03 and 0.04, respectively. In the anteroposterior direction, the greatest inaccuracy was found at the MB cusp of tooth 26 in the maxilla-first group (mean deviation 1.42 ± 0.86 mm) and at the MB cusp of tooth 16 in the mandible-first group (mean deviation 1.47 ± 0.79 mm).
Conclusions: The accuracy of the maxilla after bimaxillary orthognathic surgery in patients with skeletal asymmetry was comparable between the maxilla-first and mandible-first sequencing techniques. The statistically significant differences found in the roll and yaw axes were not clinically relevant. Similar postoperative accuracy and intraoperative benefits suggest that the mandible-first sequence may be the preferred technique in patients with skeletal asymmetry.
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