The general formula in traditional orthognathic treatment has consisted of a variable length of preoperative orthodontic preparation, surgery itself, and a period of postoperative orthodontics. An important percentage of patients will rate the orthodontics as the worst part of their treatment owing to the appliances visibility, worsening of the aesthetics during decompensation and length of overall treatment.

Recently, the performance of surgery without orthodontic preparation (i.e. “surgery first”), followed by regular postoperative dental alignment, has been proposed.

Object of study: Prospective analysis of 15 consecutive cases managed with the “surgery first” approach

Methods: We used this approach to correct skeletal malocclusions in 15 patients between 2009 and 2011. Nine cases underwent bimaxillary surgery. The rest were treated with either maxillary or mandibular procedures. Evaluation of treatment time (surgical and orthodontic), complications, achievement of planned results and patient satisfaction was done.

Results : Mean total treatment time was 9.5 months (range 6–13). In all cases, immediate profile improvement after surgery was greatly appreciated by the patients. No complications were documented. All patients rated satisfaction as very high.

Conclusion: The “surgery first” approach in orthognathic surgery might be a faster yet safe alternative to treat dentofacial deformities in selected cases.

Indications, limitations and technical aspects of this novel approach will be discussed.

Conflict of interest : None declared.