Panoptic evaluation of maxillomandibular stability and quality of life after surgery-first approach versus conventional three-stage method in skeletal Class III orthognathic surgery—systematic review and meta-analysis

This study was performed to comprehensively evaluate the outcomes of the surgery-first approach (SFA) compared to the conventional three-stage method (CTM) in skeletal Class III deformity patients, in terms of stability, quality of life, and treatment time. The search covered the period 2010–2022. Heterogeneity was assessed and the stability was subgroup analysed into two-jaw and one-jaw surgery. Thirty-three studies were identified, 29 were included in the meta-analyses. Overall anteroposterior stability of the maxilla and mandible did not differ significantly between CTM and SFA groups (maxilla, P = 0.77; mandible, P = 0.072). In two-dimensional radiographs, the results for anteroposterior stability of the mandible were in favour of CTM (P = 0.051); conversely, vertical stability of the mandible showed better results with SFA (P = 0.051). SFA patients showed a significantly shorter treatment time (P < 0.001) and better quality of life (22-item Orthognathic Quality of Life Questionnaire) at 6 months follow-up (P = 0.042). In conclusion, CTM supports better anteroposterior stability. Nevertheless, SFA provides greater vertical stability in the mandible and is associated with a shorter treatment time and better quality of life. However, only six of the 33 included studies were randomized controlled trials, hence in view of the weakness of the evidence, the results should be interpreted with caution.