Surgery-first approach on patients with temporomandibular joint disease by intraoral vertical ramus osteotomy

Orthognathic surgery followed by postsurgical orthodontics without presurgical orthodontic treatment, known as the surgery-first approach (SFA), has become favored recently. The advantages of this surgical approach include total treatment time reduction, psychological benefit from a limited duration of unesthetic orthodontic appliances, and a more effective orthodontic movement of the dentition postoperatively through a regional acceleratory phenomenon. SFA has been previously described in the literature as a surgical technique with Le Fort I osteotomy and sagittal split ramus osteotomy (SSRO), which helps maintain postoperative occlusion with rigid fixation; however, patients with temporomandibular joint disorder (TMD) are better candidates for the intraoral vertical ramus osteotomy (IVRO) surgical technique instead of SSRO. The authors report 2 cases with excellent surgical outcomes and resolution of TMD symptoms on patients with mandibular prognathism via SFA using IVRO technique.