Avascular osteonecrosis of the jaw following orthognathic surgery: a systematic review

Orthognathic surgery plays a crucial role in restoring occlusal function and improving facial aesthetics. Avascular osteonecrosis of the jaw is a rare but severe postoperative complication. Here, we reviewed the clinical characteristics and management of avascular osteonecrosis of the jaw following orthognathic surgery. A systematic review of published studies up to April 2026 was conducted. Data on clinical features, potential contributing factors, and management strategies were collected. This review included 17 studies encompassing 33 cases. Avascular osteonecrosis of the jaw was predominantly located in the maxilla (28/33), with the majority of cases (18/33) affecting the alveolar bone of the maxilla. Early symptoms primarily included gingival or soft tissue discoloration (14/33). As necrosis progressed, symptoms such as tooth loss, alveolar bone loss, oronasal fistulas, and others were observed. Management followed a staged approach: non-surgical interventions for initial control and surgical interventions for progressive cases. Thirteen cases ultimately underwent bone grafting and flap reconstruction. Larger sample sizes and higher-quality studies are needed to further understand this rare but serious complication.