Incidence of auditory alterations following orthognatic surgery: a systematic review

Orthognathic surgery is an established procedure for correcting skeletal dentofacial deformities, with proven benefits for occlusion, facial esthetics, and airway function. Despite its overall safety, it can be associated with complications, including transient or persistent auditory alterations, such as otalgia, tinnitus, and Eustachian tube dysfunction. These changes may result from altered peritubal muscle tension, surgical trauma, postoperative edema, or pre-existing conditions, like serous otitis media.

To systematically review and quantitatively synthesize the incidence and types of auditory alterations following orthognathic surgery, evaluate their association with surgical intervention, and investigate the influence of postoperative time on symptom resolution.

A comprehensive search strategy was applied using the COCHRANE Library, EMBASE, PubMed/MEDLINE, LILACS, LIVIVO, Scopus, and Web of Science, complemented by gray literature searches via Google Scholar and ProQuest Dissertations. Reference lists of eligible studies were screened, and an expert was consulted for additional records. Searches were performed in June 2023 and updated in March 2025, with no restrictions on date or language.

Eligible studies included randomized controlled trials, nonrandomized trials, cohort studies, and cross-sectional studies assessing auditory function in nonsyndromic adults undergoing orthognathic surgery, using validated auditory tests or self-reported outcomes. Comparisons had to be made between pre- and postoperative assessments or with control groups.

Two reviewers independently screened studies, extracted data, and assessed risk of bias. Individual study estimates were summarized descriptively, with odds ratios and proportions presented through graphical visualizations. Lollipop plots were used to display point estimates with corresponding 95% confidence intervals. Certainty of evidence was graded using the GRADE approach.

Nine studies (n = 6-257 participants) were included. The reported incidence of postoperative auditory alterations varied widely, ranging from <10% to >60% across studies. Estimates for audiometric changes, middle-ear function, and otalgia were imprecise and inconsistent, with wide confidence intervals frequently crossing the null. While some studies described transient symptoms such as tinnitus, otalgia, and Eustachian tube dysfunction, these findings were not uniformly observed. Overall, the certainty of the evidence was rated as very low.

The available evidence does not demonstrate a consistent association between orthognathic surgery and auditory alterations. Although transient changes may occur in the early postoperative period, they tend to resolve spontaneously and were not shown to persist reliably. Given the very low certainty of evidence, future research with standardized assessments, larger sample sizes, and longer follow-up is needed to clarify the true frequency, duration, and clinical significance of these outcomes.

PROSPERO CRD42024523742.