Intraoperative Navigation in Orthognathic Surgery: Mitigating Iatrogenic Complications

Orthognathic surgery requires precise manipulation of skeletal structures in close proximity to highly sensitive nerve, vascular, and airway anatomy. Rare iatrogenic injuries including hemorrhage and neurovascular compromise are reported and can have devastating sequelae including stroke, blindness, and death. Established technologies have primarily focused on positional accuracy rather than enhancing patient safety. This review investigates the adoption of intraoperative navigation in orthognathic surgery to reduce the risk of iatrogenic complications. Following PRISMA guidelines, a systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted to identify original studies reporting on the application and outcomes of intraoperative navigation in orthognathic surgery. Data were extracted on indications, surgical procedures, navigation technologies, primary purpose for use, and outcomes. Thirty studies met inclusion criteria, and most were published after 2015 (63.3%). The majority (96.7%) used navigation to enhance accuracy of skeletal segment positioning; only 6.7% of studies reported use of intraoperative navigation to identify and avoid critical anatomic structures. BrainLab systems were most frequently used (40.0%), followed by Stryker (13.3%) and Aurora/Northern Digital Inc. (10.0%). Extensive evidence across multiple surgical specialties validates the efficacy of intraoperative navigation in reducing injury to critical structures and in limiting blood loss, operative time, and reoperation rates. Current literature supports intraoperative navigation as a highly accurate modality for orthognathic surgery but rarely addresses its potential to mitigate severe iatrogenic complications. Evidence from other surgical disciplines substantiates its role in enhancing safety, underscoring the need for high-level studies focused on complication prevention in orthognathic surgery.