Perioperative management in orthognathic surgery-a narrative review

Background and Objective: Orthognathic surgery, also known as corrective jaw surgery, entails a complex process including diagnosis and treatment planning, the surgical execution and perioperative phase, and surgical convalescence. High-quality perioperative care can reduce complications, improve outcomes, improve patient satisfaction, and reduce healthcare costs. The objective of this narrative review is to compile the most up-to-date recommendations in perioperative care in orthognathic surgery patients with the goal of improving outcomes for patients. Methods: A literature review utilizing PubMed, Google Scholar, and Cochrane Database of Systematic Reviews was conducted to investigate perioperative management strategies in orthognathic surgery. Key Content and Findings: The perioperative period begins with the preoperative phase where labs, consent, and patient education are reviewed in addition to a history and physical exam. The airway exam is of particular importance to ensure appropriate accommodations have been made in preparation for surgery. In recent years, standardized enhanced recovery after surgery (ERAS) protocols utilizing multimodal anesthesia have been developed to improve patient outcomes. Multimodal analgesia, which involves the use of different classes of analgesics with varying mechanisms of action, is a cornerstone in managing postoperative pain and minimizing the reliance on opioids. Intraoperatively, adjunctive medications such as ondansetron, dexamethasone, propofol, dexmedetomidine, tranexamic acid (TXA), local anesthesia, and nonopioid alternatives may be utilized to decrease the incidence of postoperative nausea and vomiting (PONV), decrease blood loss, and decrease opioid usage. Postoperatively, the patient is monitored closely to ensure airway patency in addition to attempts to decrease pain, anxiety, and PONV. Patient education throughout the entire perioperative period is crucial for success in orthognathic surgery. Traditionally, patients have stayed at least one night in the hospital postoperatively, but new studies have demonstrated the feasibility of same-day discharge when applicable. Conclusions: Despite many improvements, there has not been a comprehensive narrative review article on advances in perioperative management in orthognathic surgery. Utilizing the techniques and recommendations from the latest studies to improve perioperative care can improve outcomes for orthognathic surgery patients, particularly in terms of decreasing opioid usage, PONV, blood loss, and length of hospital stay.