Intermaxillary Fixation Screws (IMF) & Surgery First Approach: A Novel Combination and Case Report

Orthognathic surgery, a pivotal treatment for patients with significant facial aesthetic and occlusal concerns, traditionally involves a phased approach comprising preoperative orthodontics, surgery, and postoperative orthodontic treatment. However, the extended duration of conventional methods often leads to patient dissatisfaction. In response, the surgery-first approach (SFA) has emerged as an alternative, aiming to streamline treatment and reduce complexity. This case report explores the implementation of the SFA without preoperative orthodontics, focusing on its integration with intermaxillary fixation (IMF) screws. A 25-year-old male presented with severe mandibular retrognathia and facial asymmetry. The radiographic evaluation confirmed the skeletal discrepancy, prompting a surgical solution. Utilizing three-dimensional (3D) planning software, LeFort I osteotomy for maxillary advancement and bilateral sagittal split osteotomy (BSSO) for mandibular setback was planned. IMF screws were strategically placed to stabilize the maxillomandibular complex intraoperatively. Immediate postoperative orthodontic adjustments-initiated dentition alignment and leveling. Regular follow-up ensured treatment progress and stability. The use of IMF screws in the surgery-first approach facilitated precise surgical movements, accelerated treatment timelines, and enhanced patient comfort. This adjunctive technique represents a promising avenue for improving surgical precision and patient outcomes in orthognathic surgery. Further research is warranted to explore the long-term stability and broader applicability of this approach across diverse patient populations.