[Postoperative stability in orthognathic surgery: from predictors to challenges4]

Postoperative stability is crucial for maintaining the long-term functional and aesthetic outcomes of orthognathic surgery. What is the current state of the science concerning skeletal and soft tissue stability following orthognathic surgery, and what are the predictors, clinical manifestations of relapse and implications for clinical action? Sagittal skeletal stability is generally high and well predictable, although specific patient- and surgery-related risk factors, including progressive condylar resorption, can result in clinically relevant relapse. Evaluation of soft tissue stability is less straightforward, considering physiological aging processes often have a larger influence than the rather limited postoperative skeletal changes. In addition, notching of the mandibular inferior border may occur, even though this phenomenon is generally a radiological finding, and only becomes aesthetically visible in a small portion of patients. With preventive strategies this can be avoided, and therapeutic treatments are also available. A patient-centred approach to postoperative stability is proposed, aligned with the primary treatment objectives and the principles of value-based care.