**5. Algorithm for performing orthognathic surgery and TJR**

It is important to remember that the surgical procedure combines both an intraoral and extraoral approach. The reconstruction of the temporomandibular joint uses extraoral approaches only, while orthognathic surgery is performed from an intraoral approach only. Due to the risk of infectious contamination of the prosthesis [2, 15, 20], it is vital to maintain strict separation of both approaches and, of course, use separate sets of instruments for both parts of the surgery. The authors also recommend separate sets of covering for the surgical field and thoroughly covering surgical wounds with sterile foils after completing individual steps of the procedure.

Basically, 2 types of surgical procedures are performed:


Both types of surgery can be supplemented by intraorally performed genioplasty at the end of the procedure.

Note 1: If the fixative part of the condylar component of the prosthesis is longer and extends to at least the first molar (often in patients with hemifacial microsomia), the authors recommend waiting to perform genioplasty. This is to limit the contact between the intraoral environment and the prosthesis due to tissue preparation during genioplasty.

Note 2: Successful orthognathic surgery with TMJ reconstruction requires experience in performing both types of surgical procedures. At the authors' workplace, these procedures are performed by 2 surgeons, an orthognathic surgeon and a TMJ surgeon, at the same time.
