Maxilla Versus Mandible First in Bimaxillary Osteotomies: Sequencing in Orthognathic Surgery

Bimaxillary orthognathic surgery can be performed in two consecutive steps: The classic approach requires osteotomy and position correction in the maxilla first, followed by osteosynthetic stabilization of the maxilla. The osteotomy and position correction is then performed in the lower jaw. Alternatively, the osteotomy and rigid fixation of the mandible can be performed first—“mandible first,” before the Le-Fort I osteotomy is performed. The decision depends on the preference and experience of the surgeon, the anatomy, and the orthognathic planning. In certain cases, the “mandible first” approach is preferred. Each case should be evaluated and assessed individually.