This study was designed as ‘an overview’ of secondary studies and analysed 15 articles. Two procedures were considered highly unstable, a bilateral sagittal split osteotomy for clockwise rotation of the mandible with bi-cortical screw rigid internal fixation, and posterior maxillary expansion with semi-rigid fixation. However, mandibular advancement or setback are both considered highly stable and they consider this as a result of the Surgeon’s experience. Larger moves in the mandible are not less stable than smaller moves. Surgical procedures of the maxilla are deemed more unstable than those performed in the mandible, although the surgical treatment of the anterior open bite being thought of as one of the most stable procedure. The hierarchical pyramid they outline is comprehensive for the procedures and fixation utilised.

Hierarchy of surgical stability in orthognathic surgery: overview of systemic reviews.

Haas Junior OL, Guijarro-Martinez R, de Sousa Gil AP, et al. 

INTERNATIONAL JOURNAL OF ORAL & MAXILLOFACIAL SURGERY
2019;48:1415-33.
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Stuart Clark

Manchester Royal Infirmary, Manchester, UK.

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