Litigation in Craniofacial Surgery in the US: An Analysis of Lawsuits Over 4 Decades

Craniofacial surgeons face significant medico-legal risks due to high procedural complexity and patient expectations. Despite extensive studies on plastic surgery litigation, the specific trends and risk factors for craniofacial malpractice lawsuits remain poorly understood. This study aims to analyze litigation trends, outcomes, and contributing factors in craniofacial surgery over 4 decades.

A retrospective review of the Westlaw and LexisNexis legal databases was conducted for lawsuits involving craniofacial surgery between 1981 and 2024. Cases explicitly involving craniofacial surgery were included. Data were extracted on patient demographics, surgeon characteristics, allegations, procedural details, geographic distribution, and legal outcomes. Descriptive statistics were conducted.

A total of 49 lawsuits across 23 states were identified, with the South accounting for the highest proportion of cases (31%). Most plaintiffs were male (55%), and 57% were adults. The most litigated craniofacial procedures included palatoplasty (n=8), cranial vault reconstruction (n=7), facial fracture repair (n=6), and mandibular reconstruction (n=4). Allegations involved deviation from standard of care (51%) and physical injury (22%). Although the majority of cases were either dismissed or resulted in defendant verdicts (59.2%), 30.6% resulted in financial settlements or plaintiff verdicts, with an average payout of $2.5 million ($15,381.31-$19,283,579). Temporal analysis revealed increasing litigation over time.

Litigation in craniofacial surgery has increased significantly, with high financial and professional implications for surgeons. Strengthening adherence to clinical guidelines, improving informed consent processes, and fostering patient trust may mitigate risk. Further research is needed to explore international trends and the impact of evolving legislation.