The surgical sequence of combined total maxillary and mandibular osteotomies

In many instances, orthognathic surgical cases require multiple osteotomies in the maxilla and mandible to achieve the most desirable result. When the entire maxilla and mandible are freed from their relationship with the remaining craniofacial complex, accurate repositioning and adequate stabilization can present problems. These problems can be minimized by operating in the proper sequence or by staging the procedure. Staging should be considered for the more complicated cases; in any instance, the maxilla should be operated on first.