Abstract: Objective：To evaluate the clinical efficacy of surgery first or surgery early approach for skeletal Class Ⅲ malocclusion.. Methods： A retrospective analysis of medical records was conducted in 37 patients with skeletal Class Ⅲ malocclusion, who were treated with surgery-first approach in our hospital from July 2010 to June 2017, and preliminary analysis was carried out on the clinical efficacy. Results：All patients were successfully completed the whole procedure with surgery-first approach and all of them were satisfied with the appearance and occlusion, excepting for one case with mild recurrence. The whole period was 6-19 months, with an average of 13.8 months. Conclusions： Computer assisted surgery-first approach can be used in treatment for skeletal Class Ⅲ malocclusion, which not only can shorten the treatment period, but can obtain satisfactory clinical efficacy.