Sequence of treatment in mandibular prognathism patients

Intraoral vertical ramus osteotomy (IVRO) and edvancement genioplasty are effective and predictacle methods of treating selctive individuals with mandibular prognathism. The sequence of performing these procedures does have a clinical implication of the sequence of procedures and to recommend the preffered sequence based on experience. A retrospective study was conducted om 75 patients treated by IVRO with or without genioplasty. In 31 patients, IVRO was performed without genioplasty; only one patient suffered from transient hypoesthesia. When IVRO was performed before genioplasy (sequence I) in 20 patients, nine suffered from mental nerve hypoesthesia. However, when IVRO was performed after genioplasty (sequence II) in 24 patients, permanent mental nerve anesthesia occured in five patients and mental nerve hypoesthesia in 15 patients. Based on these results, it is recommended that IVRO be performed before genioplasty.