Orthognathic Surgery Complications and Outcomes

Orthognathic surgery is generally safe, but it carries a characteristic profile of complications — most commonly neurosensory disturbance of the inferior alveolar nerve, along with bleeding, infection, unfavourable splits, skeletal relapse, and, less often, condylar resorption. Understanding this profile and the determinants of stable, satisfying outcomes is central to appraising the surgery.

Definition

Orthognathic surgery complications and outcomes denote the adverse events associated with corrective jaw surgery (such as nerve injury, bleeding, infection, unfavourable osteotomy, relapse, and condylar resorption) and the functional, occlusal, aesthetic, and patient-reported results by which its success is judged.

Scope

This topic surveys the complications of corrective jaw surgery — neurosensory, haemorrhagic, infective, technical (bad split, malunion), and skeletal relapse — together with condylar resorption and the measurement of functional, aesthetic, and patient-reported outcomes. It is a reference overview of risks and results, not advice on managing any individual case.

Core questions

• Which complications are most frequent after orthognathic surgery, and how often are they lasting?
• What drives skeletal relapse, and which movements and fixation choices make a result less stable?
• What is condylar resorption, and why does it threaten long-term occlusal stability?
• How are outcomes measured beyond occlusion — through airway, aesthetics, and quality of life?

Key concepts

• Neurosensory disturbance of the inferior alveolar nerve
• Intraoperative haemorrhage
• Unfavourable (bad) split and malunion
• Infection and hardware failure
• Skeletal relapse and stability hierarchy
• Progressive condylar resorption
• Patient-reported and quality-of-life outcomes

Mechanisms

Complications arise at predictable points: handling of the inferior alveolar nerve during the mandibular split produces neurosensory disturbance; osteotomy near vascular structures and the pterygoid region underlies bleeding; and atypical fracture propagation causes an unfavourable split. After healing, the new skeletal position can drift back toward the original (relapse) when movements are large, soft tissues resist, or fixation is inadequate, following a recognised hierarchy of stability. Separately, progressive condylar resorption — a gradual loss of condylar volume, more often reported in particular risk groups — can reduce ramus height and reopen the bite over months to years. Outcomes are judged not only by occlusion but by airway, facial aesthetics, and patient-reported quality of life (Chow, 2007; Jedrzejewski, 2015; He, 2019).

Clinical relevance

This entry frames how the benefits of orthognathic surgery are weighed against its characteristic risks and how stability and satisfaction are assessed. It describes evidence on complications and outcomes and does not provide guidance for the management of any individual patient.

Epidemiology

Large reviews find that most orthognathic procedures are completed without major complication and that serious events are uncommon, while minor and transient problems — above all neurosensory disturbance after mandibular surgery — are frequent (Chow, 2007; Jedrzejewski, 2015). Persistent altered sensation is reported in a minority after sagittal split osteotomy, with frequency depending on age, technique, and assessment method (Colella, 2007). Progressive condylar resorption is comparatively rare but clinically important because of its effect on long-term stability (He, 2019).

History

As orthognathic surgery became routine, systematic study of its complications and of skeletal stability matured alongside it. Long-term case series and systematic reviews catalogued the frequency and persistence of nerve disturbance, bleeding, and relapse, established hierarchies of movement stability, and characterised progressive condylar resorption as a distinct late threat, while outcome assessment broadened from occlusion alone to airway, aesthetics, and patient-reported quality of life (Chow, 2007; Jedrzejewski, 2015; He, 2019).

Debates

Cause and management of progressive condylar resorption

Progressive condylar resorption after orthognathic surgery is incompletely understood, and whether it is best prevented, observed, or treated by condylar or joint surgery — and in whom — remains contested in the systematic-review literature.

Key figures

• Nabil Samman
• Larry M. Wolford
• William R. Proffit

Seminal works

• chow-2007
• jedrzejewski-2015

Frequently asked questions

What is the most common complication of orthognathic surgery?

Altered sensation in the lower lip and chin from disturbance of the inferior alveolar nerve during mandibular surgery. It is common in the early weeks, usually improves over months, and persists to some degree in a minority of patients.

Why can the bite shift again after surgery?

The repositioned jaws can drift back toward their original position (relapse) when movements are large, soft tissues pull against them, or fixation is insufficient; less commonly, gradual loss of condylar bone (condylar resorption) reduces ramus height and reopens the bite over time.