الفهرس 
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Abstract
This work was conducted to evaluate the surgery-first orthognathic approach in management of dentofacial skeletal deformities with two concerns of the treatment; first was the skeletal stability after surgery ,the functional and aesthetic outcomes and the second was the whole treatment plan period for both surgical intervention and orthodontic treatment.
Between June 2021 and March 2023 , A longitudinal observational study was directed on a total number of twelve adult patients (five males and seven females) selected from those admitted to the Maxillofacial and Plastic Surgery Department, Faculty of Dentistry, Alexandria University suffering from dentofacial skeletal deformities with inclusion criteria of patients aged from 18 to 30 years, having class III skeletal deformities with minimally crowding in the anterior teeth (2-5 mm), favorable curve of spee (0-2mm), with or without facial asymmetry .
All the patient were prepared for the surgery by tha same protocol, all the patients evaluated clinically by checking the patient profile and occlusion and radiologically by panoramic and lateral cephalometric x-rays. Studing models were obtaine for all the patient as well.
Orthodontic brackets were bonded for all the patients in a period of 24-48 hours before surgery , no orthodontic treatment was done before surgery, the surgical wafers utiliezd in this study were all conventionally fabricted in the orthodontic lab,orthodontic department ,faculty of dentistry ,Alexandria univeristy except for only one patient who was in need for segmented maxillary surgery the surgical wafers were fabricated digitally.
Lefort I osteomtomy and bilateral sagittal split ostotomies were the osteotomies employed in all the patients presented in the study, Fixation of all osteotomies starting by the maxilla followed by the mandibular osteotomies into the proper new anatomical position by adaptation of miniplates along Champy’s line of ideal osteosynthesis also was done in all the included patients.
The patients were evaluated clinically and radiologically during the whole treatment period with a time regimen of 3, 6 months postoperatively and then 3 months after debonding. Evaluation was performed by routine panoramic X-rays, cephalometric radiographs and study models to evaluate the treatment outcome.
A difficulty index was recorded at the first orthodontic session, postoperatively and at after 3 months of debonding.
The newer surgery‑first orthognathic approach involves first performing orthognathic surgery, followed by follow-up and completion of the case with postsurgical orthodontic settling and correction of the occlusion. This has two distinct advantages over the conventional approach. First, immediate, and early correction of the facial deformity resulted in a remarkable improvement in facial appearance, which in most cases was what had prompted the patient to seek treatment. The patient, encouraged and motivated by the obvious and appreciable esthetic results, complies happily and well with the subsequent postsurgical orthodontic treatment, thus certifying an optimum occlusion with complete functional rehabilitation. The second benefit of the surgery‑first orthognathic approach is a markedly condensed overall treatment time, which is greatly valued by patients.