Should orthognathic surgery be performed in growing patients? A scoping review

The aim of this study was to determine whether the benefits of orthognathic surgery in a growing individual outweigh its risks. A scoping review was performed according to the PRISMA-ScR guideline. A bibliographic search from MEDLINE, Cochrane Library and LILACS was conducted until February 1, 2022. Scientific publications which reported orthognathic surgery in individuals under 18 years of age were considered. Inclusion criteria were performed according to PICOS model: do individuals with dentofacial deformity submitted to orthognathic surgery with an immature skeleton other than waiting growth cessation have overall benefits over any possible pos-operative consequences? Predictor of interest was growth status and outcome variables were positive benefits or negative consequences related to orthognathic surgery. Two reviewers screened records independently, and any disagreement between them was resolved by a third reviewer. Eligible studies were compiled into an extraction data form and were verified for validity and reliability. Risk of bias between studies was carried out using Review Manager. A total of 15 articles were included in this scoping review, comprising retrospective studies (9), case reports (3), and surveys (3). The topics covered varied from assessment of the functional needs, role, quality of life after orthognathic surgery, impact on growth, relation with temporomandibular joint surgical treatments, minimal referral age for surgery by orthodontists and complex cranio-maxillofacial deformities. Due to the heterogeneity of the articles, it was not possible to perform a meta-analysis. Within the limitations of the study it seems that the existing evidence seems favorable towards the intervention, improving quality of life in growing individuals, even at the risk of a second surgery.