# Current Trends in Orthognathic Surgery in Poland--A Retrospective Analysis of 124 Cases
## 4 Discussion
For skeletal Class II, one jaw surgeries were significantly more frequent than in the treatment of skeletal Class III (67.5% vs. 36.2%; \(p=0.0023\)). The results correspond with the reports of numerous authors, where the correction of skeletal Class III is treated by two jaw corrective osteotomy. It may result from the greater patients' awareness of the safety of bimaxillary surgery, better aesthetic results and the most important effect, which is stable treatment results after using BIMAX surgery [32; 33]. Surgeons also use treatment of skeletal Class II based on one jaw BSSO surgery as a popular therapeutic option [14; 32; 33]. In our study, we broke down the type of sagittal split ramus mandibular osteotomy into two of its modifications (Obwegeser-Dal Pont vs. Obwegeser-Epker). We find no such a breakdown in the literature, where sagittal and split osteotomies as a whole are referred to as BSSO (bilateral sagittal split osteotomy) procedures. Therefore, this topic is not referred to in the discussion. The sequence of osteotomy performed in bimaxillary surgery is still the subject of debate [34; 35]. Classically, the first orthognathic surgeries started with maxillary osteotomy--because of not a very stable connection between osteotomy fragments and greater stability of the jaw after its fixation. Currently, as a result of the enormous progress and the use of miniplate osteosynthesis for stabilizing the fragments, the decision on the order of osteotomies depends solely on the surgeon's preferences. The sequence of surgery is usually determined by an anticipated movement of the maxillomandibular complex, and, as a result, stability of the location of the osteotomy fragments [35; 36; 37]. Our study showed that in 61.3% of cases of bimaxillary surgeries surgery was started with osteotomy of the mandible. No statistically significant correlation between skeletal Classes II and III and the order in which osteotomy was performed in bimaxillary surgeries was found (\(p=0.727>0.05\)). Adjunctive procedures during orthognathic surgery may be an important part of the treatment [25]. A study of a large group of 101,692 orthognathic patients in the United States showed that for 19.6% of cases adjunctive procedures were performed during surgery. The authors mentioned genioplasty, septoplasty and rhinoplasty as adjunctive procedures [38]. Our analysis revealed that adjunctive procedures were performed in 27.4% of all surgeries. However, genioplasty was excluded from adjunctive procedures, since it was classified as a separate surgery. Septoplasty was the most common adjunctive procedure in 13.7% of cases. No statistically significant adjunctive procedures were performed for skeletal Classes II and III (<0.001) in our study. The longest surgery in our study was bimaxillary osteotomy with genioplasty (mean = 265 min, SD = 34). The mean duration of bimaxillary osteotomy is 210 min (SD = 34), and for one jaw surgery it is 132 min (SD = 33). The shortest procedure turned out to be isolated genioplasty (mean = 96 min, SD = 30). The results correspond with the studies carried out by other researchers [39; 40]. [PERSON] et al. report bimaxillary surgery performed within 223 min (SD = 42). The duration of Le Fort I one jaw osteotomy is 133 min (SD = 39), and for BSSO it is 103 min (SD = 33). In another study, [PERSON] et al. reported that the mean time for bimaxillary osteotomy (n = 107) was 139.3 min, for Le Fort I osteotomy (n = 42) it was 82.2 min, and for BSSO (n = 102) it was 80.3 min [41]. In this case, our analysis does not correspond with the results of the study in which the duration of all orthognathic procedures was shorter. No seasonal nature of the duration of surgery was found in our analysis. No seasonal distribution in the procedures was found in the study group, which does not correspond with the study carried out by [PERSON] and [PERSON] [33]. They revealed a clear seasonal variation, that demonstrated peaks every winter and summer during summer and winter breaks at schools in Korea.