Most of the important decislons concerning a maxillofacial surgical procedure should be made long before the administration of anesthesia. The decision to perform surgery should be the culmination of several diagnostic steps be the analytic approach the surgeon first identifies tile varfPus signs and symptoms and relevant historical. information; then, using available data and logical reasoning, the surgeon establishes the relationship between’ the  individual problems .

The initial step in the presurgical evaluation is the collection of accurate and pertinent data. This is accomplished through patient interview.s; physical, laboratory, and imaging examinations; and the use of consultants
when necessary. Patient interviews and physical examinations should be performed in an unhurried, thoughtful fashion. The surgeon should not be willing to accept incomplete data, such as a poor-qualiry radiograph, especially when it is probable that ·additional data might
change decisions concerning surgery. For a good analysis, data must be organized intoa form
that allows for hypothesis testing; that is, the dentist should be able to consider a list of possible diseases and eliminate- those unsupported by the data. By using this method, along with the knowledge-of which diseases have a probability of being present, the surgeon is usually able
to reach a decision about whether surgeryis indicated.

Clinicians also must be thoughtful observers. Whenever a procedure is performed, they should note all aspects of its outcome to advance their surgical know ldure s hould also be followed whenever a clinician is
learning about a new technique. In additiorra clinician. should practice evidence-based dentistry by evaluating, he purported results of any new technique by weighing the scientific merit of studies used to investigate the technique. Frequently, scientific methods are violated by the unrecognized introduction of a placebo effect, observer bias, patient variability, or use of in.adequate control groups.

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