The hidden cost of the perfect case report: Are we publishing only successes?

Case reports play a critical role in Oral and Maxillofacial Surgery (OMFS) by documenting rare presentations, unexpected complications, and complex intraoperative events. However, contemporary publication patterns suggest a bias toward reporting "ideal" outcomes, potentially limiting opportunities for complication-based learning.

A narrative review of bibliometric studies and large-scale clinical reports published between 2008 and 2025 was conducted using journal archives and database searches (PubMed, Scopus). The review synthesised trends in case report publication across major OMFS journals and compared these with real-world complication rates reported in high-volume clinical studies.

Case report publications in OMFS journals have progressively declined over the past decade. In BJOMS, complication- or novelty-focused short communications decreased from 52 % in 2008-2009 to 35 % in 2010-2011. In contrast, large clinical cohorts document substantial adverse event rates, ranging from 3.6 % in third molar surgery to 43.7 % in orthognathic surgery. This discrepancy highlights a growing gap between clinical reality and published literature.

The underrepresentation of complication-focused case reports skews perceptions of OMFS practice and limits experiential learning. Transparent, structured reporting of complications can enhance patient safety, strengthen surgical education, and better align published evidence with real-world outcomes. Journals should adopt policies that encourage and normalize the publication of clinically meaningful adverse events.