Facial Palsy after Orthognathic Surgery: Incidence, Causative Mechanism, Management, and Outcome

Background: Facial palsy after orthognathic surgery is an uncommon but serious complication causing dissatisfaction and affecting quality of life. The occurrence could be underreported. Surgeons need to recognize this issue regarding the incidence, causative mechanism, managements, and outcome. Methods: A retrospective review of orthognathic surgery records between January of 1981 and May of 2022 was conducted in the authors’ craniofacial center. Patients who developed facial palsy after the surgery were identified, and demographics, surgical methods, radiologic images, and photographs were collected. Results: A total of 20,953 sagittal split ramus osteotomies (SSROs) were performed in 10,478 patients. Twenty-seven patients developed facial palsy, resulting in an incidence of 0.13% per SSRO. In a comparison of SSRO technique, the Obwegeser-Dal Pont technique using osteotome for splitting had higher risk of facial palsy than the Hunsuck technique using the manual twist splitting ( P < 0.05). The severity of facial palsy was complete in 55.6% of patients and incomplete in 44.4%. All patients were treated conservatively, and 88.9% attained full recovery in a median duration of 3 months [interquartile range (IQR), 2.75 to 6 months] after surgery, whereas 11.1% attained partial recovery. Initial severity of facial palsy predicted the timing of recovery, with incomplete palsy patients having faster median recovery (3 months; IQR, 2 to 3 months) than the complete palsy patients (6 months; IQR, 4 to 6.25 months) ( P = 0.02). Conclusions: The incidence of facial palsy after orthognathic surgery was 0.13%. Intraoperative nerve compression was the most likely causative mechanism. Conservative treatment is the mainstay of therapeutic strategy, and full functional recovery was anticipated. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.